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ROBINSON'S    PRESCRIPTION    INCOMPATIBILITIES 

A  TREATISE  ON 

PRESCRIPTION 
INCOMPATIBILITIES 

AND  DIFFICULTIES 

INCLUDING  PRESCRIPTION  ODDITIES  AND  CURIOSITIES 

FOR  PHARMACISTS  AND  PHYSICIANS  AND  STUDENTS 
IN  PHARMACY  AND  MEDICINE 

BY 

WILLIAM  J.  ROBINSON,  Pn.G.,  M.D. 

EDITOR   OF  THE   CRITIC  AND  GUIDE   AND  THE   AMERICAN  JOURNAL 
OF  UROLOGY   AND  SEXOLOGY 

Formerly  President  New  York  Board  of  Pharmacy  Intlitute;  Fellow  New  York  Academy 
of  Medicine,  American  Medical  Association,  member  Sew  York  State  and 
County  Medical  Society,  American  Association  for  the  Advance- 
ment of  Science,  etc.,  etc. 

Author:  Organic  Materia  Medico,  Potology  and   Toxicology:  Elementary  Count  in 

Chemistry;  Elementary  Course  in  Pharmacy;  A   Complete  Quiz  System  of 

Pharmacy:  Practical  Druagi.it  Institute  Course  of   Pharmacy; 

A  Practical  Courts  in  Pharmacy,  Chemistry,  Materia 

Medina  and  Toxicology. 

Author:  Sex  Knowledge  for  Men;  Woman:  Her  Sex  and  Lote  Life;  Treatment  of  Sexual 
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itation of  Offspring  by  the  Prevention  of  Conception; 
Never  Told  Tales;  Eugenic*  and  Marriage, 
etc.,  etc. 


1919 
CRITIC  AND  GUIDE  COMPANY 

12  MX.  MORRIS  PARK  WEST 

NEW  YORK 


BY  THE  SAME  AUTHOR 

A  PRACTICAL  TREATISE  ON  THE  CAUSES, 
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BIRTH  CONTROL  OR  LIMITATION  OF  OFF- 
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CEPTION    1 .50 

SEX   MORALITY — PAST,   PRESENT   AND 

FUTURE 1.50 

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PRESCRIPTION  INCOMPATIBILITIES 3.00 

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Copyright,   1919, 
BY  THE  CRITIC  AND  GUIDE  Co. 


TO  THE  MEMORY 

OF 
CHARLES    RICE 

ONE  OF  THE  NOBLEST  REPRESENTATIVES  OF 
PROFESSIONAL  PHARMACY 

IN  THIS   COUNTRY 

A  MODEST  AND  UNSELFISH  MAN  OF  SCIENCE 

I  GRATEFULLY  AND  REVERENTLY 
DEDICATE  THIS  VOLUME 

W.J.R. 


PREFACE 

FRANKNESS  demands  the  statement  that  the  subject  of 
Prescription  Incompatibilities  is  of  considerably  less 
importance  now  than  it  was  twenty  or  thirty  years 
ago.  It  was  a  rare  day  then  when  an  editor  of  a  pharma- 
ceutical journal  or  one  who  was  considered  an  expert  in 
solving  incompatible  riddles  did  not  receive  orally  or  in  writ- 
ing a  despairing  call  for  help  from  some  sorely  puzzled  drug- 
gist, who  in  attempting  to  put  up  a  prescription  as  written 
by  the  doctor,  got  an  unsightly,  impossible  mass,  a  strange, 
unlooked-for  color,  or  perhaps  a  dangerously  explosive  mix- 
ture. And  pharmaceutical  journals  devoted  a  good  deal  more 
space  than  they  do  now  answering  the  " incompatible" 
queries  of  their  subscribers.  The  flood  of  new  remedies  and 
synthetics  was  then  at  its  height  and  the  physician  still  un- 
weaned  from  his  habit  of  polypharmacal  prescribing  insisted 
on  joining  together  things  which  the  spirits  of  chemistry, 
pharmacy  and  therapeutics  intended  should  be  kept  asunder. 
The  idea  at  that  time  was  still  pretty  general  that  the  value 
of  a  prescription  increased  in  direct  ratio  to  the  number  of 
its  ingredients.  And  the  result  was — not  infrequently — a 
spoiled,  useless,  ludicrous,  or  even  dangerous  combination. 
Things  are  different  now.  Our  propaganda  during  the 
past  twenty-five  years  in  favor  of  simple  rational  prescriptions 
has  borne  fruit.  The  modern  physician  does  not  believe  in 
shotgun  prescriptions ;  he  prescribes  one,  seldom  more  than 
two  or  three  active  ingredients  in  a  prescription.  In  fact, 
the  tendency  is  now  towards  the  other  extreme :  single  reme- 
dies is  the  slogan,  the  physician  thus  not  infrequently  de- 
priving himself  of  valuable  synergistic  or  corrective  combi- 

5 


6  PREFACE 

nations.  Of  course,  the  fewer  the  ingredients  in  a  prescrip- 
tion, the  fewer  the  chances  for  incompatible  combinations  or 
impossible  absurdities. 

Nevertheless,  the  days  of  incompatible  prescriptions  and 
questionable  combinations  are  not  entirely  over.  Not  as 
often  as  formerly,  but  still  often  enough  is  the  author  ap- 
pealed to  to  clear  up  difficult  points  in  physicians'  prescrip- 
tions, and  it  is  lack  of  time,  and  not  lack  of  opportunity, 
that  prevents  him  from  playing  the  role  of  oracle  on  in- 
compatibilities to  the  pharmaceutical  profession.  No,  the 
subject  of  incompatibilities  has  not  yet  altogether  lost  its 
importance.  And  every  intelligent  pharmacist  as  well  as 
every  self-respecting  and  conscientious  physician  should  be 
on  terms  of  familiarity  with  the  salient  facts  of  prescription 
writing,  so  that  the  latter  may  avoid  and  the  former  correct 
glaring  absurdities. 

It  is  just  a  quarter  of  a  century  since  the  author  began 
to  teach  and  to  write  on  the  subject  of  this  book.  His  first 
Treatise  on  Prescription  Incompatibilities  and  Difficulties 
appeared  in  Merck's  Report,  where  it  ran  for  several  years. 
In  a  revised  form  it  was  published  in  The  CRITIC  and  GUIDE 
for  1903,  1904  and  1905.  It  is  not  a  mere  phrase  to  state 
that  the  Treatise  met  with  exceptional  favor.  It  was  claimed 
that  the  author  was  the  only  writer  in  the  field  who  suc- 
ceeded in  making  a  dreary  and  dry-as-dust  subject  readable 
and  interesting.  And  being  interesting,  the  subject  became 
memorizable;  it  left  an  impression  on  the  tablets  of  one's 
memory,  which  a  dreary,  non-interesting  subject  rarely  does. 
The  requests  to  reprint  the  Treatise  in  a  separate  volume 
were  quite  numerous— but  then  a  busy  practice  and  other, 
more  interesting  literary  work  made  compliance  with  the  re- 
quest a  practical  impossibility.  And  with  each  year  that 
passed  the  Treatise  became  more  inadequate — because  new 
remedies  came  into  use  and  with  them  new  incompatibili- 
ties, and  the  composition  of  certain  pharmacopeial  galenicals 
became  changed,  so  that  explanations  and  criticisms  which 


PREFACE  7 

held  good  before,  held  good  no  longer.  To  bring  the  Treatise 
on  Prescription  Incompatibilities  up  to  date  required  con- 
siderable additions,  a  few  eliminations  and  a  thorough  re- 
vision. I  despaired  of  ever  having  the  time  to  devote  to  it. 

But  I  recently  achieved  some  leisure  and  I  have  taken  the 
opportunity  to  subject  the  Treatise  to  a  thorough  revision 
and  to  bring  it  up  to  date.  And  I  now  take  pleasure  in  pre- 
senting this  enlarged  and  revised  Treatise  on  Prescription 
Incompatibilities  and  Difficulties,  including  Prescription 
Oddities  and  Curiosities,  to  my  friends  in  the  pharmaceutical 
and  medical  professions. 

A  word  on  the  kind  of  prescriptions  and  incompatibilities 
that  are  discussed  in  this  Treatise.  They  are  bona  fide  pre- 
scriptions and  combinations,  and  the  incompatibilities  are 
such  as  have  presented  themselves  to  some  druggists  and 
physicians  and  are  apt  to  present  themselves  again  to  others. 
It  is  not  only  superfluous  and  unnecessarily  space-consum- 
ing, but  it  is  mind-confusing  and  discouraging  to  present 
incompatibilities  in  prescriptions  which  never  happened  and 
never  could  happen,  because  no  physician  in  his  wildest  flights 
of  fancy  would  ever  think  of  writing  such  combinations. 

Let  me  illustrate  by  some  examples:  Of  what  use  is  it 
to  tell  a  physician  or  a  pharmacist,  or  a  medical  or  pharma- 
ceutical student,  that  mucilage  of  acacia  is  precipitated  by 
sodium  phosphomolybdate,  that  acetanilid  gives  a  white  pre- 
cipitate with  bromine,  that  meconic  acid  gives  a  precipitate 
with  barium  chloride,  that  urethane  give  off  some  ammonia 
when  heated  with  a  solution  of  potassium  or  sodium  hy- 
droxide, that  cadmium  salts  are  precipitated  by  alkali  car- 
bonates and  chromates,  that  gamboge  with  ammonia  water 
gives  a  yellow  colored  solution,  that  a  mixture  of  cocaine 
and  calomel  acquires  a  dark  color  if  the  fumes  of  hydro- 
chloric acid  are  blown  over  it,  that  a  solution  of  methyl- 
thionine  hydrochloride  is  precipitated  by  potassium  bichro- 
mate, that  piperazine  explodes  when  heated  to  a  certain  tem- 
perature with  sodium  hypochlorite,  that  potassium  salts  give 


8  PREFACE 

a  yellow  precipitate  with  platinic  chloride  and  hydrochloric 
acid,  that  sugar  is  decomposed  with  ignition  by  concentrated 
sulphuric  acid,  that  thymol  is  incompatible  with  chromic 
acid,  etc.,  etc. — the  list  could  be  extended  indefinitely. 

It  is  not  merely  superfluous,  but,  as  stated  above,  is  confus- 
ing and  discouraging  to  the  student.  For,  seeing  that  most 
drugs  have  dozens  and  some  even  hundreds  of  incompati- 
bilities, he  loses  courage  and  despairs  of  ever  mastering  the 
subject.  Why,  many  of  the  chemicals  given  as  incompatibles 
of  this,  that  and  the  other  thing  are  not  even  medicinal 
preparations,  are  never  used  in  medicine,  are  never  prescribed 
and  consequently  can  never  form  the  subject  of  prescription 
incompatibilities!  Who  ever  heard  of  a  doctor  prescribing 
acacia  with  sodium  phosphomolybdate,  acetanilid  with  bro- 
mine (elementary  bromine!)  ?  And  of  what  interest  is  it  to 
a  student  of  incompatibilities  to  know  that  meconic  acid 
is  incompatible  with  barium  chloride  ?  Have  the  two  ever  been 
prescribed?  And  has  a  doctor  ever  prescribed  sugar  with 
concentrated  sulphuric  acid?  Or  has  anybody  ever  ordered 
to  blow  the  fumes  of  HC1  over  a  mixture  of  cocaine  and 
calomel?  And  so  on.  So  what  is  it  all  for?  The  examples 
I  have  enumerated  are  chemical  tests  and  reactions— they  are 
useful  in  their  place,  but  they  have  nothing  to  do  with  the 
subject  of  incompatibilities.  This  book  will  be  found  free 
from  the  superfluities  referred  to,  and  will,  it  is  hoped,  be 
found  more  acceptable  and  more  useful  on  that  account. 

W.  J.  R. 

12  Mount  Morris  Park  West 


INTRODUCTION 

THE  subject  of  incompatibilities  has  always  been  the 
bete  noire  of  the  pharmacist  and  physician.  Whether 
it  is  because  the  subject  is  really  a  difficult  one,  or 
because  it  has  not  received  proper  and  satisfactory  treat- 
ment in  our  text-books,  in  our  pharmaceutical  and  medical 
journals,  or  because  the  educational  standard  of  the  pharma- 
cist and  physician  is  not  high  enough,  not  broad  enough  to 
enable  them  to  master  the  subject  thoroughly,  certain  it  is 
that  the  number  of  pharmacists  and  physicians  who  are  able 
to  grapple  successfully  with  all  the  intricacies  of  prescrip- 
tion incompatibilities  is  a  very  limited  one.  It  shall  be  the 
purpose  of  this  treatise  to  solve  the  many  mysteries  of  incom- 
patibilities. It  is  the  author 's  conviction,  based  upon  an  expe- 
rience of  many  years,  that  there  is  no  subject,  no  matter  how 
apparently  intricate  and  complicated,  that  cannot  be  mas- 
tered by  a  person  of  average  intelligence,  provided  it  be 
presented  in  the  proper  light  and  in  a  proper  manner;  that 
there  is  no  subject,  no  matter  how  dry,  that  cannot  be  made 
interesting  and  attractive. 

The  author's  opportunities  for  seeing  and  analyzing  incom- 
patible prescriptions  have  always  been  exceptionally  favor- 
able ones.  Besides  the  large  collections  he  has  made  in  his 
quondam  drug-store  practice,  he  is  constantly  receiving  in- 
quiries from  pharmacists  in  various  parts  of  the  city  and 
country,  regarding  some  mooted  points.  He  is  also  fre- 
quently honored  with  letters  from  physicians,  who,  on  getting 
untoward  effects  from  some  combinations,  ask  for  enlighten- 
ment. They  frequently  inquire  whether  it  is  the  fault  of 
the  combinations,  or  whether  the  druggist  had  perhaps  sub- 


10  PRESCRIPTION  INCOMPATIBILITIES 

stituted  something  else  for  what  had  been  prescribed. 
Finally,  the  author  had  been  for  a  number  of  years  regular 
" consultant"  to  a  number  of  pharmaceutical  journals  and 
in  this  capacity  he  has  had  to  analyze  and  explain  incom- 
patible prescriptions  almost  daily. 

As  to  why  I  consider  the  subject  of  prescription  incompati- 
bilities of  such  paramount  importance  to  the  pharmacist,  I 
can  do  no  better  than  to  quote  from  a  paper  of  mine  on  the 
subject,  read  at  the  Twenty-second  Annual  Convention  of 
the  New  York  State  Pharmaceutical  Association.  I  started 
that  paper  by  stating  that  the  business  of  the  retail  pharma- 
cist of  the  present  day  consisted  of  three  branches:  that  of 
manufacturing  galenical  preparations,  that  of  selling  patent 
medicines,  druggists'  sundries,  etc.,  and  that  of  dispensing 
physicians '  prescriptions. 

The  first  two  departments  have  been  encroached  upon  to 
a  very  great  extent.  The  large  manufacturing  houses  with 
limitless  facilities,  improved  machinery,  immense  capital  and 
modern  methods  have  been  able  to  offer  certain  classes  of 
preparations  to  the  retail  druggist  at  such  a  price  as  to  take 
away  from  him  every  incentive  to  do  his  own  manufactur- 
ing. And  there  is  no  help  for  that.  No  matter  how  we  may 
deplore  the  fact  that  the  druggist  of  the  present  day  is 
unable  to  spread  a  plaster  or  roll  a  pill  so  dexterously  as  did 
the  apothecary  of  a  generation  or  two  ago,  you  cannot  change 
the  tendency  of  the  times.  For  the  sake  of  sentiment  no 
druggist  will  spend  several  hours  in  making  a  preparation, 
which  he  can  purchase  ready  made  and  as  well  made  at  a 
lower  price. 

The  sale  of  patent  medicines,  etc.,  is  being  every  day  more 
and  more  monopolized  by  the  department  stores.  This  is 
also  inevitable,  as  will  be  admitted  by  any  one  who  has 
given  the  subject  some  thought  and  who  can  read  the  signs 
of  the  times. 

But  there  is  one  department  which  is  still  the  pharmacist's 
own— a  department  which  distinguishes  him  as  a  profes- 


PRESCRIPTION  INCOMPATIBILITIES  11 

sional  man  and  elevates  him  above  the  ordinary  merchant. 
I  refer  to  the  prescription  department.  That  is  a  depart- 
ment which  nobody  can  take  away  from  the  pharmacist ;  be- 
cause, while  no  law  can  be  passed  to  prevent  people  from 
selling  ordinary  drugs  and  patent  medicines,  the  dispensing 
of  prescriptions  can  be  limited  to  qualified  pharmacists  only. 
And  to  the  development  of  this  department  the  pharmacist 
should  devote  his  best  energies.  To  do  this  successfully  he 
must  become  a  master  prescriptionist  and  be  familiar  with 
all  the  intricacies  of  prescription  incompatibilities.  Nothing 
will  more  securely  hold  your  physician's  patronage  than  his 
confidence  in  your  ability  as  a  prescriptionist,  in  your  abil- 
ity to  dispose  of  difficulties  and  to  prevent  untoward  results. 

It  has  always  been  a  source  of  wonder  to  me  why  the  sub- 
ject of  incompatibilities  has  been  so  sadly  neglected  in  our 
college  curricula.  The  student  is  taught  the  various  steps 
of  preparing  sulphuric  acid,  or  of  the  preparation  of  soda  by 
the  Leblanc  process  (things  of  which  he  will  never  make  any 
practical  application),  but  he  is  left  in  ignorance  as  to  how 
to  mix  Fowler's  solution  and  Magendie's  solution  without 
precipitation.  He  is  taught  the  difference  between  cast  and 
wrought  iron,  but  he  is  left  in  ignorance  as  to  why  a  pre- 
cipitate occurs  on  the  addition  of  potassium  iodide  to  syrup 
of  ferrous  iodide  and  how  to  prevent  it. 

To  me  the  subject  of  prescription  incompatibilities  has 
always  seemed  of  paramount  importance.  It  is  practically 
more  useful  than  botany,  more  useful  than  pharmacognosy, 
and  even  more  useful  than  manufacturing  chemistry — and  I 
hope  the  time  is  not  far  distant  when  it  will  occupy  the  first 
rank  in  the  curriculum  of  every  school  of  pharmacy  in  the 
United  States. 

THE   MEANING  OP  "INCOMPATIBLE" 

The  word  "incompatible,"  according  to  the  definition  of 
the  various  dictionaries,  means  incapable  of  existing  together 
in  agreement  or  harmony.  We  call  a  prescription  incompati- 


12  PRESCRIPTION  INCOMPATIBILITIES 

ble  when  its  ingredients  are  of  such  a  nature  that,  if  brought 
together,  one  or  more  of  the  following  changes  would  take 
place:  (1)  Mutual  decomposition  of  the  ingredients,  with 
the  formation  of  a  new  compound;  (2)  precipitation,  chemical 
or  physical;  (3)  explosion;  (4)  deflagration;  (5)  liquefac- 
tion, when  the  ingredients  are  prescribed  in  powders;  (6)  the 
deterioration  or  destruction  of  one  or  more  of  the  ingredients. 

But  it  would  be  a  mistake  to  suppose  that  the  word  incom- 
patible is  synonymous  with  "non-dispensable."  On  the  con- 
trary, as  will  be  seen  later,  there  are  many  combinations 
which,  broadly  speaking,  are  incompatible,  but  not  only  may 
they  be  dispensed  without  any  hesitation,  the  incompatibility 
is  intentional  and  distinctly  desirable. 

Incompatibilities  are  generally  divided  into  three  classes: 
(1)  Chemical  incompatibility,  where  the  change  is  the  result 
of  a  true  chemical  reaction,  e.  g.,  when  sodium  salicylate  is 
prescribed  with  diluted  sulphuric  acid,  salicylic  acid  precipi- 
tates out,  and  sodium  sulphate  is  in  solution;  (2)  pharma- 
ceutical, when  the  change  is  the  result  of  a  physical  condi- 
tion, i.  e.,  when  the  menstruum  is  unsuitable,  e.  g.,  when 
fluid  extract  of  cannabis  indica  is  added  to  water  and  the 
resin  is  thrown  out  of  solution;  and  (3)  therapeutic,  where 
the  drugs  prescribed  have  antagonistic  medicinal  properties 
(as  when  chloral  and  strychnine  are  prescribed  together,  or 
digitalis  and  aconite).  With  the  latter  variety,  therapeutic 
incompatibility,  the  pharmacist  has  absolutely  nothing  to  do, 
nor  is  he  to  permit  himself  to  make  any  suggestions  to  the 
physician  in  that  direction.  The  pharmacist  is  not  compe- 
tent to  judge  of  what  constitutes  therapeutic  incompatibility ; 
it  is  none  of  his  affair ;  fwo  drugs  may  be  antagonistic  in  one 
respect  and  synergistic  in  another,  and  it  is  for  the  latter 
effect  that  the  physician  prescribes  them. 

The  author's  classification  of  incompatibilities,  which  he 
introduced  several  years  ago  and  which  has  been  found  both 
useful  and  practical,  is  as  follows: 

(1)  Permissible  and  desirable  incompatibility,  when  the 


PRESCRIPTION  INCOMPATIBILITIES  13 

resulting  change  is  of  no  significance,  or  where  the  new  com- 
pound is  expressly  desired  by  the  physician. 

(2)  Preventable  incompatibility,  where  the  incompatibil- 
ity can  easily  be  prevented,  either  by  a  change  in  the  order 
of  mixing  the  ingredients,  or  by  the  addition  of  acid,  etc.,  and 

(3)  Absolute,  or  true,  incompatibility,  where  the  prescrip- 
tion cannot  possibly  be  dispensed  in  its  original  form  and 
where  one  or  more  ingredients  must  be  left  out  altogether 
or  other  ingredients  substituted.    It  is  this  last  kind  of  in- 
compatibility which   is   practically   synonymous  with   non- 
dispensability.     This  classification  I  have  found  especially 
useful  for  students. 


PRESCRIPTIONS 

TO  master  the  subject  of  incompatibilities,  each  prescrip- 
tion should  be  read  carefully.     It  is  not  necessary  to 
attempt  to  memorize  all  incompatibilities;  but  it  is  im- 
portant to  try  to  understand  the  general  principles.    At  the 
end  of  the  volume,  the  incompatibilities  will  be  summarized 
and  classified  alphabetically,  so  that  they  can  be  easily  re- 
ferred to. 

I.    Morphinae  Sulphatis gr.  iv 

Ac.  Tannici  gr.  viii 

Aquae  Destillatae 3  ij 

Inject  with  ear  syringe. 

I  start  this  series  of  incompatible,  difficult  and  odd  prescrip- 
tions with  the  above,  because  it  is  so  very  common.  With  all 
that  has  been  written  on  prescription  incompatibilities  one 
would  think  that  such  a  combination  would  not  present  any 
difficulty  to  any  pharmacist.  But  such,  it  appears,  is  not 
the  case.  The  druggist  seemed  to  be  very  much  surprised 
and  indignant  at  the  fact  that  a  "precipitate  formed  when 
he  added  the  tannic  acid  to  the  solution  of  morphine,  which 
did  not  dissolve  on  long  shaking."  Well,  a  precipitate  does 
form  when  tannic  acid  is  added  to  morphine,  and  not  only 
to  morphine,  but  to  all  other  alkaloids.  This  is  one  of  the 
commonest  kind  of  incompatibility  that  we  encounter  in  the 
drug  store  practice. 

ALKALOIDS  ARE  INCOMPATIBLE  WITH  TANNIC  ACID  OR  WITH 
SUBSTANCES  CONTAINING  TANNIN. 

The  alkaloid  is  precipitated  out  of  its  solution  as  a  tan- 
nate. 

In  the  above  prescription  we  see  a  good  example  of  true 
15 


16  PRESCRIPTION  INCOMPATIBILITIES 

incompatibility.  The  physician  apparently  prescribed  the 
tannic  acid  as  an  astringent  to  stop  a  discharge  in  the  ear; 
the  canal  of  the  ear  being  painful,  he  also  prescribed  mor- 
phine sulphate  with  the  intention  of  diminishing  the  pain, 
but  this  latter  object  is  completely  defeated,  because  the 
morphine  sulphate  is  converted  into  the  insoluble  morphine 
tannate,  which  being  insoluble  cannot  be  absorbed  and  can- 
not act.  Even  the  astringent  action  of  the  tannic  acid  is 
diminished,  because  a  part  of  the  latter  is  precipitated  and 
is  in  combination  with  the  morphine. 

2.    Morphinae  Sulphatis   gr.  iv 

Ammonii  Carbonatis   3  jss 

Syr.  Senegae 3  ss 

Aquae q-s.  ad     §  iij 

S.    Teaspoonful  4  times  a  day,  as  directed. 

A  very  common  prescription,  but  incompatible  neverthe- 
less. The  morphine  is  precipitated  in  the  alkaloidal  form 
by  the  ammonium  carbonate  which  is  a  strong  alkali.  Of 
course  putting  a  shake  label  on  the  bottle  diminishes  the 
danger  to  a  great  extent,  but  it  does  not  entirely  eliminate 
it.  As  a  general  rule  mixtures  with  poisonous  precipitates 
or  sediments  should  not  be  dispensed. 

In  the  above  prescription,  the  syrup  of  senega  alone  would 
have  a  tendency  to  precipitate  the  morphine  because  it  con- 
tains some  water  of  ammonia. 

ALKALOIDS  ARE  PRECIPITATED  BY,  AND  THEREFORE  INCOMPAT- 
IBLE WITH,  ALKALINE  HYDROXIDES,  THEIR  CARBONATES  AND  Bi- 

CARBONATES  AND  WITH  SALTS  HAVING  AN  ALKALINE  REACTION. 

Such  are :  potassium  hydroxide,  carbonate  and  bicarbonate ; 
sodium  hydroxide,  carbonate  and  bicarbonate;  ammonium 
hydroxide  (=  ammonia  water)  and  carbonate;  calcium 
hydroxide  (=  lime  water)  ;  sodium  borate  and  sodium  phos- 
phate, the  latter  salts  having  an  alkaline  reaction.  Magnesium 
hydroxide,  Mg(OH)2,  has  the  same  tendency,  but  its  solu- 
bility is  very  slight  and  it  is  seldom  prescribed  in  combina- 
tion with  alkaloids. 


PRESCRIPTION  INCOMPATIBILITIES  17 

3.  Morphinae  Sulphatis  gr.  ij 

Antimon.  et  Potass.  Tartratis gr.  ij 

Amraon.  Chloridi   3  j 

Syr.  Pruni  Virgin 3  ij 

Tannic  acid  is  an  excellent  precipitant  of  tartar  emetic  (the 
precipitate  formed  is  antimony  tannate),  and  wild  cherry 
contains  a  large  amount  of  tannic  acid.  The  morphine  will 
also  be  precipitated,  as  morphine  tannate.  It  is  true  that 
no  reports  of  bad  results  have  ever  reached  me — probably 
because  the  precipitates  are  so  well  suspended  in  the  thick 
syrup.  Nevertheless,  the  combination  is  not  a  good  one.  If 
it  is  dispensed,  a  "shake"  label  should  invariably  accom- 
pany it. 

TANNIC  ACID  PRECIPITATES  AND  Is  THEREFORE  INCOMPATI- 
BLE WITH  TARTAR  EMETIC  (  ANTIMONY  AND  POTASSIUM  TAR- 
TRATE). 

4.  Fluidextr.   Cannabis  Indie 3  ij 

Kali  Bromati 3  vj 

Aquae  Menthae  Pip 3  "J 

The  resins  contained  in  the  cannabis  indica  precipitate 
when  added  to  water.  The  finely  divided  precipitate  grad- 
ually collects  in  little  lumps.  A  nice  homogeneous  mixture 
can  be  made  by  rubbing  the  fluidextract  with  one  or  two 
drams  of  acacia,  and  then  gradually  adding  some  water  so 
as  to  form  an  emulsion.  The  mixture  will  also  have  a  much 
less  disagreeable  taste ;  so  that  both  from  a  pharmaceutical 
and  a  gustatory  point  of  view  the  employment  of  acacia  is 
not  only  justifiable,  but  clearly  indicated.  This  is  a  typical 
example  of  pharmaceutical  incompatibility. 

RESINOUS  FLUIDEXTRACTS  AND  TINCTURES  PRECIPITATE 
WHEN  MIXED  WITH  WATER. 

5.  Hydrogenii  Peroxidi 

Aquae  Calcis    aa  60.0 

S.    Use  for  throat  in  atomizer. 
On  mixing  the  two  solutions  a  whitish  precipitate  is  no- 


18  PRESCRIPTION  INCOMPATIBILITIES 

ticed.  This  precipitate  is  generally  considered  to  consist  of 
calcium  sulphate  or  calcium  phosphate,  the  formation  of  those 
precipitates  being  due  to  the  sulphuric  or  phosphoric  acid 
contained,  in  small  amounts,  in  the  peroxide  of  hydrogen. 
This  explanation  is  true  as  far  as  it  goes,  but  it  does  not 
go  far  enough.  The  precipitate  also  occurs  in  varieties  of 
peroxide  of  hydrogen  which  contain  no  sulphuric  or  phos- 
phoric acid,  but  only  hydrochloric  acid.  It  certainly  cannot 
be  due  to  the  latter,  because  calcium  chloride  is  a  very  solu- 
ble salt.  No,  the  chief  precipitate  is  due  to  the  formation 
of  calcium  peroxide,  which  is  a  white  crystalline  compound. 
The  equation  is  a  simple  one : 

Ca(OH),  +  ILO,  =  Ca02  +  2ILO. 

The  question  under  discussion  is  not  one  of  theoretical 
interest  only ;  it  is  of  great  practical  importance.  If  the  pre- 
cipitation were  due  to  the  formation  of  calcium  sulphate  or 
phosphate  only,  no  objections  could  be  raised  to  the  prescrip- 
tion. In  fact,  except  for  the  precipitate  clogging  the  holes 
in  the  atomizer,  the  addition  of  lime  water  to  peroxide  of 
hydrogen  might  be  considered  an  advantage,  because  the  acid- 
ity of  the  latter  becomes  neutralized  and  the  sharp  burning 
taste  is  lost.  But  having  learned  that  the  peroxide  becomes 
decomposed,  we  see  that  the  combination  is  an  inadmissible 
one. 

IT  Is  BEST  NOT  TO  PRESCRIBE  LIME  WATER  AND  PEROXIDE 
OF  HYDROGEN  IN  THE  SAME  MIXTURE. 

I  might  add  that  calcium  peroxide  is  a  commercial  prod- 
uct, being  sold  under  various  names  as  a  gastrointestinal  anti- 
septic. 

6.  Protargol gr.  ij 

Zinci  Sulphatis gr.  iij 

Aquae  Destillatae 3  iv 

M.f.  Collyrium. 

This  prescription  is  absolutely  incompatible.  On  adding 
the  zinc  sulphate  to  the  protargol  solution  the  latter  becomes 


PRESCRIPTION  INCOMPATIBILITIES  19 

completely  decolorized,  while  at  the  same  time  a  rather  abun- 
dant precipitate  takes  place.  (The  precipitate  is  soluble  in 
ammonia  water.)  To  dispense  it  with  the  precipitate  is  of 
course  inadmissible,  the  prescription  being  intended  for  an 
eye  wash,  or  eye  drops.  The  druggist  who  received  this  pre- 
scription, dispensed  it  after  filtering  out  the  precipitate.  A 
very  poor  way.  It  is  much  better  to  leave  out  the  sulphate 
of  zinc  and  notify  the  physician. 

PROTAHGOL  Is  ABSOLUTELY  INCOMPATIBLE  WITH  ZINC  SUL- 
PHATE. 

7.  Tr.  Ferri  Chloridi 3  ss 

Syr.  Simplicis  $  J 

Aquae  Cinnamomi q.s.  ad  5  iv 

It  does  not  seem  as  if  anything  could  be  the  matter  with 
this  innocent  prescription,  but  there  is.  The  cinnamic  alde- 
hyde present  in  the  oil  of  cinnamon  (from  which  the  water  is 
prepared)  reacts  with  the  ferric  chloride;  the  solution,  at  first 
clear,  becomes  after  a  short  time  turbid  and  dirty-looking, 
and  a  slight  deposit  forms.  It  is  best  to  substitute  another 
water  for  the  cinnamon  water,  with  the  physician's  knowl- 
edge, of  course,  but  if  the  prescription  must  be  dispensed  as 
written,  the  patient  should  invariably  be  informed  of  the 
change  in  the  appearance  which  the  medicine  will  undergo 
in  a  few  hours.  Otherwise  he  will  be  almost  sure  to  bring 
it  back  the  next  day,  with  the  question  if  a  mistake  had 
not  been  made,  or  if  the  medicine  did  not  get  spoiled.  If  the 
patient  is  prepared  for  such  a  thing  he  will  never  make  any 
fuss  about  it;  on  the  contrary,  his  respect  for  the  druggist's 
knowledge  and  predicting  powers  will  be  greatly  increased. 

8.  Tr.  Ferri  Chloridi 3  ij 

Spir.  Pimentae  3  j 

Syrupi  Sacehari  3  J 

Aquae   q.s.  ad  3  iij 

The  Eugenol  present  in  the  oil  of  pimenta  reacts  with  the 
ferric  chloride,  producing  a  turbidity  in  the  mixture,  with  the 


20  PRESCRIPTION  INCOMPATIBILITIES 

final  deposition  of  a  dark-brown  precipitate.  The  same  reac- 
tion takes  place  if  Aqua  Pimentae  is  used  instead  of  the 
spirit.  The  remarks  concerning  the  preceding  prescription 
apply  also  to  this  one. 

9.  Acidi  Tannici ^  j 

Aquae  Calcis 3  1V 

S.    Use  as  a  gargle. 

Tannic  acid  is  incompatible  with  lime  water.  When  the 
two  are  mixed,  a  bulky,  bluish-white  precipitate  results.  The 
precipitate  is  a  tannate  of  calcium,  though  its  composition 
is  somewhat  variable.  The  prescription  should  hardly  be 
dispensed. 

LIME  WATER  AND  OTHER  SOLUBLE  CALCIUM  SALTS  ARE  IN- 
COMPATIBLE WITH  TANNIC  Aero. 

10.  Glyceriti  Ac.  Tannici 3  ij 

Aquae  Calcis  3  VJ 

S.    Use  as  a  gargle. 

The  same  reaction  takes  place  here,  only  the  precipitate  is 
of  a  whitish  color  and  is,  on  account  of  the  glycerin,  more 
evenly  distributed.  This  prescription  may  be  dispensed,  but 
it  is  best,  perhaps,  to  call  the  physician's  attention  to  the 
incompatibility. 

11.  Atrop.  Sulphatis £*•  v 

Ext.  Colchici  Sem.  Fl 3  *J 

Potassii  lodidi  gr.  x 

Sodii  Salicyl gr.  xx 

Tr.  Guaiaci 5  ss 

Aquae  Foeniculi q.s.  ad     3  ij 

S.      3  i  every  four  hours. 

I  present  this  prescription  not  so  much  for  its  incompatible 
points  as  for  its  peculiar  dosage.  When  the  doctor  was  told 
that  the  dose  of  atropine — %  of  a  grain — was  a  lethal  one, 
he  answered  irascibly  that  he  did  not  wish  to  be  bothered  in 
the  future;  that  we  knew  he  was  not  well  up  in  doses,  and 
that  therefore  we  could  fix  the  doses  to  suit  ourselves!  He 


PRESCRIPTION  INCOMPATIBILITIES  21 

afterwards  gave  us  carte  blanche  so  far  as  his  prescriptions 
were  concerned ;  we  could  change  the  dosage,  leave  out  ingre- 
dients (incompatible  ones),  etc.  Very  often  he  only  wrote 
the  ingredients,  leaving  it  to  us  to  fix  the  quantities.  He  has 
a  very  large  practice,  nevertheless! 

The  incompatibilities  are:  the  KI  with  the  atropine  (and 
perhaps  with  the  colchicine),  and  the  tincture  of  guaiac  with 
the  water  (the  resin  precipitates  at  once).  The  tincture 
sometimes  strikes  a  blue  color  with  acacia,  but  the  latter  may 
be  used  to  make  an  emulsion,  in  spite  of  this. 

12.    Argenti  Nitrici gr.  xv 

Aquae  Destillat  5  i 

Detur  in  vitro  nigro  et  signa:     Pro  usu  externo. 

This  is  a  perfectly  innocent  and  compatible  prescription, 
but  the  making  up  of  it  afforded  a  good  deal  of  amusement ; 
the  senior,  the  junior,  and  even  the  boy  joined  in  the  result- 
ing merriment.  The  incident  related  here  took  place  in  the 
old  land-mark  pharmacy,  at  the  corner  of  Houston  and  Clin- 
ton streets,  this  city,  II.  L.  Metz  and  then  Nicholas  Tauszig, 
proprietors.  It  was  on  a  Sunday,  the  boss  was  out,  and  busi- 
ness was  exceedingly  rushing.  One  hundred  and  fifty  to  two 
hundred  prescriptions  a  day  was  the  general  average,  but  that 
day  the  number  was  much  greater.  There  were  besides  quite 
a  few  "hard"  prescriptions,  such  as  500  silver-coated  creo- 
sote pills,  120  suppositories,  500  cachets,  etc.  A  sign  was 
therefore  put  out:  "Relief  clerk  wanted."  Soon  a  young 
man  presented  himself,  who  said  he  had  worked  in  a  drug- 
store on  the  other  side,  but  could  find  no  position  here  and 
would  be  glad  to  relieve  for  $2.00  an  afternoon.  The  first 
two  prescriptions  he  made  up  all  right.  The  third  prescrip- 
tion was  the  above.  He  went  to  the  poison  closet,  where  we 
used  to  keep  all  potent  drugs,  found  the  bottle  with  the 
label  Argentum  nitricum,  weighed  out  the  alleged  silver  ni- 
trate, put  it  in  a  bottle,  added  the  water,  and  started  shaking 
it;  after  shaking  violently  for  two  or  three  minutes,  finding 


22  PRESCRIPTION  INCOMPATIBILITIES 

that  the  "silver  nitrate"  would  not  dissolve,  he  emptied  the 
contents  into  a  mortar,  and  started  to  pound  the  "silver 
nitrate."  This,  of  course,  caused  surprise  to  his  fellow-pre- 
scriptionists,  and  on  looking  into  the  mortar  it  was  found 
that  the  alleged  silver  nitrate  was — flaxseed!  As  you  perhaps 
know,  fused  silver  nitrate  formerly  used  to  come  in  bottles 
filled  with  flaxseed.  This  was  done  to  prevent  the  sticks  from 
breaking.  He  was  unfamiliar  with  the  fact  and  thought,  so 
he  said,  that  the  flaxseed  was  a  special  form  in  which  silver 
nitrate  came  in  this  country.  But  we  suspected  that  he  had 
never  handled  silver  nitrate  before. 

13.    Magnes.  Calcin 3  iij 

Pulv.  Rhei 3  ij 

Pulv.  Zingiberis   3  j 

Sodii  Bicarbon 3  j 

Olei  Menthae  Pip gtt.  v 

Aquae  ad       J  iv 

After  standing  for  a  while  this  mixture  thickens  and  solidi- 
fies to  such  an  extent  that  it  is  impossible  to  either  shake  it 
or  pour  it  from  the  bottle.  The  cause  of  it  is  to  be  found 
exclusively  in  the  tendency  of  magnesium  oxide  to  combine 
with  water,  forming  a  gelatinous  hydrate :  MgO  -f  H20  => 
Mg(OH)2.  If  the  heavy  calcined  magnesia — magnesii  oxidum 
ponderosum— be  used  instead  of  the  light  magnesia,  the  ten- 
dency to  gelatinization  will  be  greatly  obviated.  Sometimes 
even  when  the  light  magnesia  is  used,  no  gelatinization  takes 
place.  This  is  due  to  the  sad  fact  that  in  some  drug-stores 
magnesia  is  handled  so  carelessly  (left  in  open  vessels,  in  a 
moist  atmosphere,  etc.),  that  in  a  short  time  the  magnesia  is 
no  longer  magnesia,  but  magnesium  carbonate  (that  is,  hydro- 
carbonate),  and  this  latter  does  not  gelatinize  with  water.  I 
have  seen  many  such  samples  of  "magnesia." 

14.    Spir.  Ammon.  Armat 3  jj 

Spir.  Menth.  Piper .*.'..  5  j 

Aquae  Calcis  [  %  VJ- 

S. :   J  ss  after  meals. 


PRESCRIPTION  INCOMPATIBILITIES  23 

A  slight  precipitate  of  calcium  carbonate  will  be  formed, 
due  to  the  ammonium  carbonate  in  the  aromatic  spirit.  The 
oils  of  both  spirits  will  be  precipitated  by  the  lime  water, 
making  a  milky  mixture;  an  inelegant  combination  but  one 
that  may  be  dispensed  with  a  "shake"  label. 

15.  Acidi  Carbol gtt.  xx 

Xatrii  Bibor 5  ij 

Natrii  Bicarb 3  ij 

Glyceriiii   5  j 

Aquae   ad       3  vii j 

S. :    Use  with  nasal  douche. 

This  is  practically  the  well-known  Dobell's  solution,  only 
modified  in  the  proportions  of  the  ingredients.  An  efferves- 
cence takes  place,  due  to  the  evolution  of  carbon  dioxide. 
What  is  this  evolution  due  to?  <;To  the  action  of  the  car- 
bolic acid  on  the  sodium  bicarbonate,"  many  would  answer. 
No ;  it  is  caused  by  the  action  of  the  boric  acid  on  the  sodium 
bicarbonate ;  the  boric  acid  being  formed  by  the  action  of  the 
glycerin  on  the  borax.  A  full  discussion  of  this  subject  will 
be  found  in  another  prescription. 

16.  Potassii  lodidi  3  v 

Tr.  Ferri  Chloridi  5  iij 

Aquae  ad   5"  iv 

S. :    3  j  t.i.d.  p.c. 

It  is  not  advisable  to  dispense  this  prescription,  as  a  con- 
siderable amount  of  iodine  is  liberated ;  not  only  by  the  free 
hydrochloric  acid  present  in  the  tincture,  but  by  the  ferric 
chloride  itself,  thus: 

2KI  +  Fe,Cl.  =  2FeCU  +  2KC1  +  I. 

IT  Is  BEST  NOT  TO  PRESCRIBE  TINCTURE  OP  FERRIC  CHLORIDE 
WITH  POTASSIUM  IODIDE. 

17.  Potass.  Brom. 

Sodii  Brom aa  3  ij 

Aquae  Camphorae 3  iy 


24  PRESCRIPTION  INCOMPATIBILITIES 

While  camphor  is  soluble  to  a  very  slight  extent  in  water, 
it  is  almost  absolutely  insoluble  in  solutions  of  salts.  In 
this  prescription  it  is  therefore  precipitated  out,  floating  on 
the  top  of  the  liquid  or  adhering  to  the  bottle  as  a  fine  scum. 

SALTS  SHOULD  NOT  BE  PRESCRIBED  TO  BE  DISSOLVED  IN 
CAMPHOR  WATER,  PARTICULARLY  IN  CONCENTRATED  SOLUTIONS. 

18.  Quinin.  Bisulph  3  i 

Amm.  Carbon 3  i 

Syr.  Simpl 3  i 

Aquae  Cinnam 1 .  3  ij 

S. :   3  i  doses. 

Attention  has  been  called  to  this  incompatible  prescription 
times  without  number,  nevertheless  it  seems  to  be  a  favorite 
with  many  physicians.  Why  physicians  will  prescribe  the 
most  soluble  quinine  salt  and  then  precipitate  it  is  beyond 
comprehension.  There  is  only  one  explanation  for  it:  the 
physician  is  not  aware  that  a  precipitation  takes  place.  The 
quinine  bisulphate,  being  seventy  times  more  soluble  than 
the  sulphate,  dissolves  easily  in  the  prescribed  quantity  of 
water;  but  the  ammonium  carbonate  (like  all  alkaline  car- 
bonates) causes  a  precipitate  of  alkaloidal  quinine. 

ALKALOIDAL  SALTS  ARE  THROWN  OUT  OP  SOLUTION  BY  AL- 
KALINE HYDROXIDES  AND  CARBONATES. 

19.  Hydrarg.  Bichlor , gr.  vj 

Syrup  Hypophosphit 5  ij 

Syr.  Sarsap.  Co 3  j 

Aquae  Menthae  Pip 3  j 

S. :   3  j  4  times  a  day. 

This  prescription  is  absolutely  incompatible.  The  hypo 
phosphites  are  strong  reducing  agents,  and  the  corrosive  sub- 
limate is  entirely  reduced :  first  to  calomel  and  then  to  metal- 
lic mercury.  Either  the  corrosive  sublimate  or  the  hypophos- 
phites  must  be  omitted. 

CORROSIVE  SUBLIMATE  AND  HYPOPHOSPHITES  ARE  ABSO- 
LUTELY INCOMPATIBLE, 


PRESCRIPTION  INCOMPATIBILITIES  25 

20.  Argenti  Nitratis gr.  iv 

Syr.  Hypophosphit   3  j 

Aquae  Dest q.s.  ad  •     %  iv 

S.:    3  j  after  meals. 

This  prescription,  too,  is  absolutely  incompatible.  The 
hypophosphites  reduce  the  silver  nitrate  to  black  metallic 
silver.  The  organic  constituents  of  the  syrup  also  help  along 
the  decomposition.  There  is  no  way  of  dispensing  the  above, 
except  by  leaving  out  either  the  first  or  second  ingredient. 
The  method  of  administering  silver  nitrate  in  solution  is  irra- 
tional. On  coming  in  contact  with  the  saliva  and  the  secre- 
tion from  the  esophagus,  the  nitrate  becomes  almost  entirely 
decomposed.  If  an  effect  on  the  bowels  or  a  systemic  effect 
is  desired,  the  best  method  is  to  administer  the  remedy  in  the 
form  of  enteric  pills ;  i.  e.,  pills  coated  with  salol  or  keratin. 

21.  Cocain.  Hydrochlor gr.  xx 

Atropin.  Sulph gr.  ijss 

Aconitin.  Nitr gr.  j 

Collodion    3  iv 

S. :  Paint  over  painful  spots  when  pain  is  acute. 
As  cocaine  hydrochloride  is  practically  insoluble  in  ether, 
and  as  collodion  consists  of  gun-cotton  dissolved  in  a  mixture 
of  3  volumes  of  ether  and  1  of  alcohol,  the  alkaloidal  salt 
will  not  dissolve.  One  of  two  things  may  be  done:  Either 
dissolve  the  cocaine  and  other  alkaloidal  salts  in  a  little  alco- 
hol (it  would  require  about  l1/^  dr.),  and  mix  the  solution 
with  the  collodion ;  or  employ  alkaloidal  cocaine,  which  is 
very  soluble  in  ether.  The  latter  course  is  preferable.  The 
two  last  alkaloidal  preparations  need  not  be  changed,  as  they 
are  in  such  small  quantity  that  the  alcohol  present  in  the 
collodion  will  dissolve  them  without  much  difficulty. 

22.  Sol.  Magendie 

Sol.  Fowleri  aa  8.0 

S. :    Gtt.  viii  t.i.d.  p.  c. 

Well  do  I  remember  this  prescription,  as  it  was  the  first 
incompatible  one  I  ever  saw.  It  was  almost  at  the  very  com- 


26  PRESCRIPTION  INCOMPATIBILITIES 

mencement  of  my  pharmaceutical  career.  The  proprietor 
mixed  the  two  solutions,  affixed  the  label,  but,  on  delivering 
it,  noticed  a  precipitate  throughout  the  entire  bottle.  He 
seemed  to  be  surprised,  and  went  again  behind  the  counter, 
mixed  the  solutions  in  different  order,  but  with  the  same  re- 
sult. After  two  or  three  more  unsuccessful  attempts,  I  was 
sent  to  the  doctor.  "Oh,  well,  if  they  don't  go  well  together, 
leave  out  the  morphine,"  said  the  doctor.  Thus,  ignorance 
deprived  the  patient  of  the  ingredient  which  he  was  prob- 
ably in  need  of.  Alkaloids,  as  we  already  know,  are  precip- 
itated by  alkalies,  their  hydroxides,  carbonates,  and  bicar- 
bonates;  Fowler's  solution  contains  free  potassium  carbonate 
(potassium  bicarbonate  is  used,  but  on  being  boiled  becomes 
converted  into  carbonate)  ;  the  pure  alkaloid  morphine  pre- 
cipitates. A  few  drops  of  diluted  HC1  added  to  the  arsenic 
solution,  before  it  is  mixed  with  the  morphine  solution,  will 
prevent  precipitation,  because  it  will  neutralize  the  potassium 
carbonate. 

23.  Antipyrini   gr.  xxx 

Syr.  Ipecac 3  iiss 

Syr.  Prun.  Virgin 3  ss 

Aquae  ad      3  " 

S.:   3i4x  a  day. 

A  flocculent  precipitate  is  formed,  due  to  the  tannic  acid  of 
the  wild  cherry  combining  with  the  antipyrine.  The  latter 
is  a  synthetic  base,  behaving  in  most  respects  as  the  alkaloids 
do,  which,  as  we  saw  before,  are  precipitated  by  tannic  acid. 
Though  the  mixture  might  be  dispensed  with  a  "shake"  label, 
it  is  better  to  call  the  physician's  attention  to  the  fact,  so 
that  he  may  in  the  future  substitute  another  syrup  for  that 
of  wild  cherry. 

24.  Antipyrini    gr.  xi 

Spir.  Aetheris  Nitr 3  ss 

Spir.  Frumenti  3  ss 

Syr.  Tolutani 

S.:    3iq.  2h. 


PRESCRIPTION  INCOMPATIBILITIES  27 

This  prescription  should  not  be  dispensed  under  any  con- 
sideration. So  it  was  taught  formerly,  but  we  are  not  so 
strict  now  on  this  point.  Antipyrine  with  sweet  spirit  of 
niter  forms  a  grass-green  solution  which  is  claimed  to  be 
poisonous.  The  exact  nature  of  the  compound  formed  has 
not  as  yet  been  established.  The  poisonousness  of  that  com- 
pound has  also  been  disputed,  and  is  in  fact  denied  alto- 
gether, but  it  is  best  to  be  on  the  safe  side,  and  not  dispense 
the  combination. 

ANTIPYBIN  SHOULD  NOT  BE  DISPENSED  WITH  SPIRIT  OP 
NITROUS  ETHER. 

25.  Antipyrini   3  ij 

Sodii  Salicyl 3  iv 

Div.  in  Pulv.  No.  xij. 

Antipyrine  and  sodium  salicylate  should  not  be  prescribed 
in  powder  form,  as  liquefaction  often  occurs,  especially  in 
damp  weather.  I  have  seen  this  prescription  dispensed,  and 
when  the  box  reached  the  patient,  there  were  only  a  few 
thoroughly  soaked  papers  in  it ;  the  patient  had  to  send  for 
other  powders.  I  reported  a  case  in  the  New  York  Medical 
Journal  where  the  prescribing  of  just  those  powders  had 
rather  disagreeable  consequences  for  the  physician. 

ANTIPYRIN  AND  SODIUM  SALICYLATE  SHOULD  NOT  BE  PRE- 
SCRIBED TOGETHER  IN  POWDER  FORM. 

26.  Potass.  lodidi  3  ij 

Spir.  Aetheris  Nitr 3  iss 

Syrupi  $  i 

Aquae   ad  3  iv 

S.:     3  i  q.  2  h. 

Potassium  iodide  and  nitrous  ether  should  never  be  pre- 
scribed together,  because  iodine  is  set  free  by  the  acids  usually 
present  in  the  nitrous  ether.  No  matter  how  fresh  the  spirit 
of  nitrous  ether  may  be,  the  liberation  of  iodine  and  discolora- 
tion of  the  mixture  are  sure  to  take  place  within  a  very  short 
time.  Neutralizing  the  spirit  with  potassium  bicarbonate  will 


28  PRESCRIPTION  INCOMPATIBILITIES 

not  remedy  the  evil.  I  experimented  in  that  line,  but  never 
succeeded  in  making  a  permanent  mixture  from  those  two 
ingredients.  The  question  in  a  recent  Board  of  Pharmacy 
examination:  "What  happens  in  a  mixture  containing  potas- 
sium iodide  and  a  decomposed  sample  of  spirit  of  nitrous 
ether  ? "  is  therefore  misleading,  as  there  is  no  line  of  demar- 
cation between  a  decomposed  and  a  non-decomposed  sample 
of  sweet  spirit  of  niter. 

POTASSIUM  IODIDE,  AS  WELL  AS  OTHER  IODIDES,  Is  INCOM- 
PATIBLE WITH  SPIRIT  OF  NITROUS  ETHER. 

27.  Hydrarg.  Oxidi  Flavi gr.  v 

Cocainae  Hydrochlor e> gr.  iv 

Ungt.  Aq.  Rosae 5  ss 

S.:     Eye  salve.    Apply  at  night. 

The  physician  prescribes  here  the  cocaine  with  the  inten- 
tion of  diminishing  any  pain  or  burning  which  the  oxide  of 
mercury  may  produce  on  the  inflamed  lids  and  conjunctivae. 
The  result  obtained  is  just  the  reverse  of  the  expected  one. 
The  salve  has  proved  exceedingly  irritating  to  the  eyes.  The 
cause  of  this  is  the  formation  of  some  mercurous  and  mercuric 
oxychloride.  The  physician's  attention  should  be  called  to 
this  fact,  and  if  he  insists  on  having  cocaine,  the  pure  alka- 
loid should  be  substituted  for  the  hydrochloride. 

28.  Cocainae  Hydrochlor gr.  v 

Sod.  Biboratis  gr.  x 

Aq.  Destillatae  3  i 

M.F.    Collyrium. 

The  sodium  borate,  which  has  an  alkaline  reaction,  precip- 
itates the  cocaine  in  alkaloidal  form.  The  proper  way  to  do 
is  to  substitute  an  equal  quantity  of  boric  acid  for  the  borax, 
or  we  may  add  a  little  glycerin.  The  latter  decomposes  the 
borax,  yielding  sodium  metaborate  and  boric  acid,  and  the 
solution  being  no  longer  alkaline,  no  precipitation  will  take 
place.  The  action  of  glycerin  on  borax  will  be  fully  dis- 
cussed in  another  prescription. 


PRESCRIPTION  INCOMPATIBILITIES  29 

29.    Quin.  Sulphatis  3  iss 

Acidi  Sulph.  Dil i 3  ii 

Sodii  Salicyl 3  ss 

Syrupi  3i 

Aquae  ad  3  iy 

I  once  watched  a  junior  compound  this  prescription.  He 
put  the  quinine  in  a  mortar,  added  some  water,  and  then  the 
dilute  sulphuric  acid;  to  this  clear  solution  he  added  the 
sodium  salicylate,  and  lo!  a  thick  mass  resulted.  He  began 
to  triturate  vigorously  with  the  pestle,  but  the  more  he 
triturated  the  more  solid  and  pasty  the  mass  became.  He 
then  began  nervously  to  add  some  more  sulphuric  acid,  think- 
ing thereby  to  dissolve  the  mass ;  but  the  more  acid  he  added, 
the  worse  the  matter  seemed  to  become.  The  entire  con- 
tents of  the  mortar  had  to  be  thrown  away.  If  made  up  in 
a  bottle,  both  the  contents  and  the  bottle  have  to  be  thrown 
away,  as  the  bottle  cannot  even  be  cleaned,  so  sticky  is  the 
mass.  The  sulphuric  acid  here  does  double  mischief;  first,  it 
dissolves  the  quinine  sulphate,  thus  permitting  it  to  fully 
react  with  some  of  the  sodium  salicylate,  forming  insoluble 
quinine  salicylate;  secondly,  it  decomposes  the  rest  of  the 
sodium  salicylate,  forming  sodium  sulphate  and  salicylic  acid, 
the  latter  of  which  precipitates.  In  order  to  be  able  to  dis- 
pense this  prescription  in  a  more  or  less  presentable  form, 
the  sulphuric  acid  must  be  left  out.  The  quinine  sulphate  is 
rubbed  up  with  about  half  of  the  water,  the  sodium  salicylate 
is  dissolved  in  the  other  half  and  mixed  with  the  syrup,  and 
this  solution  is  gradually  added  to  the  quinine  mixture  with 
agitation.  The  whole  is  dispensed  with  a  " shake"  label.  In 
this  way  practically  no  reaction  takes  place,  the  quinine  sul- 
phate being  kept  in  suspension  instead  of  being  dissolved. 

SOLUBLE  QUININE  SALTS  ARE  INCOMPATIBLE  WITH  SOLUBLE 
SALICYLATES,  THE  INSOLUBLE  QUININE  SALICYLATE  BEING 
FORMED. 


30          PRESCRIPTION  INCOMPATIBILITIES 

30.  Quin.  Sulphatis 3  i 

Acidi  Sulph.  Dil 3  ii 

Sodii  Acetatis  3  ss 

Syr.  Rubi  Idaei 3  i 

Aquae  ad  3  viij 

What  has  been  said  in  explanation  of  the  previous  prescrip- 
tion applies  with  equal  force  to  this  one.  The  bulky  quinine 
acetate  precipitates,  and  the  balance  of  the  sodium  acetate  is 
decomposed  by  the  sulphuric  acid,  with  the  formation  of 
sodium  sulphate  and  acetic  acid.  The  prescription  is  to  be 
compounded  like  the  previous  one,  i.  e.,  the  sulphuric  acid 
must  be  omitted. 

SOLUBLE  QUININE  SALTS  ARE  INCOMPATIBLE  WITH  SOLUBLE 
ACETATES. 

31.  Hydrarg.  Chlorat.  V.h.par 8  0 

S.:    For  doctor's  use. 

Late  one  evening,  when  about  to  retire,  a  messenger  came 
with  a  note  from  a  druggist,  requesting  an  explanation  of 
the  above  "mysterious"  prescription.  There  is  nothing  mys- 
terious about  it.  It  means  Hydrargyrum  Chloratum  via 
Humida  paratum,  that  is,  calomel  prepared  by  the  wet  proc- 
ess, or  by  precipitation.  The  ordinary  calomel  is,  as  we 
know,  prepared  by  sublimation  (vapore  partum).  The  calo- 
mel prepared  by  the  wet  process  is  in  a  much  finer  amorphous 
condition,  and  is,  therefore,  preferred  by  some  physicians; 
for  insufflating  into  the  eyes,  for  instance,  it  is  superior  to 
the  ordinary  variety. 

32.  Aqua  fontana 100  grms 

Ilia  repetita 45    " 

Eadem  destillata   12    " 

Hydrogenii  protoxidi 0.5  " 

Nil  aliud gtt  vi ! 

Sig.    One  drop  in  a  teaspoonful  of  water  thrice  daily. 
All  physicians  know  what  a  placebo  is,  but  many  druggists 
do  not.    It  is  a  harmless  or  inert  remedy  which  we  are  some- 


PRESCRIPTION  INCOMPATIBILITIES  31 

times  obliged  to  give  to  nervous  patients,  whom  we  feel  need 
no  medicine,  but  who  think  they  must  take  something ;  bread 
pills,  colored  water,  etc.,  are  placebos;  the  word  placebo 
means  in  Latin :  I  will  please.  The  above  placebo  is  reported 
to  have  cured  a  large  number  of  neurotic  and  cranky  women 
of  their  imaginary  ills.  It  was  prescribed  for  one  court  lady 
by  Napoleon  Ill's  physician  and  was  greatly  in  vogue  with 
the  grandes  dames  de  la  c&ur. 

As  a  few  of  my  readers  (very,  very  few,  of  course!)  may 
not  be  strong  in  Latin,  I  will  translate  the  ingredients  into 
English:.  (1)  Spring  water,  (2)  the  same  repeated,  (3)  the 
same  distilled,  (4)  hydrogen  protoxide  (i.  e.,  water) ;  (5) 
nothing  else. 

Had  the  demon  of  curiosity  not  taken  possession  of  the 
grande  dame,  she  might  have  gone  on  to  her  last  day  praising 
and  presenting  to  her  friends  the  great  prescription  of  the 
famous  Dr.  N.  But  she  could  not  resist  the  temptation.  She 
wanted  to  know  what  the  wonderful  ingredients  were.  She 
presented  the  prescription  to  numerous  physicians  and  phar- 
macists, but  they  evaded  a  direct  answer  or  said  that  those 
were  rare  medicaments  the  nature  of  which  she  would  not 
understand.  At  last  she  found  a  druggist,  who  for  a  con- 
siderable sum  of  money  revealed  the  fatal  secret.  The  wrath 
of  the  grand  lady  against  the  physician  can  be  better  imag- 
ined than  described. 

33.     Tr.  Ferri  Chlor 5  ij 

Sod.  Salicyl '. 3  iv 

Glycerini   3  * 

Aquae   ad  3  " j 

S.:    3  i  t.i.d.  p.c. 

The  salicylates  are  incompatible  with  ferric  salts,  forming 
ferric  salicylate,  of  a  deep  violet-blue  color.  This  prescription 
may  be  dispensed  but  it  is  better  to  inform  the  physician 
of  the  resulting  reaction. 

FERRIC  SALTS  ARE  INCOMPATIBLE  WITH  SALICYLATES  :  A 
DEEP  VIOLET  BLUE  COLOR  RESULTS. 


32  PRESCRIPTION  INCOMPATIBILITIES 

34.  Quin.  Sulph 3  i 

Ac.  Sulphuric!  Dil q-s- 

Tr.  Ferri.  Chlor 3  ij 

Glycerin!   3  i 

Aquae  ad  5  iij 

S. :   3  i  t.i.d.  p.c. 

As  the  physician  has  here  evidently  prescribed  the  diluted 
sulphuric  acid  merely  as  a  solvent  for  the  quinine,  it  is  best 
left  out,  as  tincture  of  ferric  chloride  (on  account  of  its  con- 
taining free  HC1)  is  an  excellent  solvent  for  quinine  salts 
in  general. 

35.  Morphin.  Sulph gr.  j 

Camphorae    gr.  xx 

Mentholis   gr.  xv 

Pulv.  Althaeae   gr.  xl 

Div.  in  pulv.  No.  x. 

Menthol  and  camphor,  when  rubbed  together  or  when  long 
in  contact,  become  liquefied.  There  is  a  way,  however,  of 
obviating  the  difficulty:  to  rub  the  camphor  with  a  portion 
of  the  althea,  the  menthol  with  the  remainder ;  then  to  divide 
the  camphor  and  menthol  separately  into  ten  powders  (one 
kind  is  wrapped  outside  with  blue  paper).  The  patient  is 
directed  to  take  one  of  each  kind  of  powder  at  a  time.  I 
do  not  particularly  recommend  this  method,  though  I  can 
see  no  special  objection  to  it. 

MENTHOL  AND  CAMPHOR  LIQUEFY  AND  ARE  THEREFORE  IN- 
COMPATIBLE WHEN  PRESCRIBED  IN  POWDER  FORM. 

36.  Morphin.  Sulph gr.  ij 

Spir.  Ammon.  Aromat. 3  ij 

Aq.  Menth.  Piper 3  v j 

S. :    3  j  when  required. 

This  prescription  is  a  dangerous  one  to  dispense.  The 
ammonia  will  precipitate  the  morphine.  As  I  said  before, 
poisonous  principles  should  never  be  dispensed  in  a  state  of 
suspension.  In  pouring  out  the  medicine,  a  dose  equivalent 


PRESCRIPTION  INCOMPATIBILITIES  33 

to  one-third,   one-half,  or  even  a  whole  grain,  may  easily 
get  into  the  spoon. 
ALKALOIDS  ARE  INCOMPATIBLE  WITH  ALKALIES. 

37.  Antipyrini gr.  viij 

Calomelanos .. .  gr.  v 

Sacch.  Lactis gr.  v 

Antipyrine  and  calomel  are  considered  incompatible.  When 
rubbed  together  or  in  contact,  in  the  presence  of  moisture 
at  a  somewhat  elevated  temperature,  corrosive  sublimate  is 
apt  to  form.  The  exact  chemical  reaction  which  takes  place 
has  not  yet  been  established  with  absolute  certainty,  but  it 
may  be  expressed  by  the  following  equation : 

3Hg,  Cl.  +  2CuHu  N,0  +  H,0  = 

Calomel          Antipyrine        Water 

Hg,0+        2HgCl»  +    Hg,+      2C,iHuN,O.  HC1 

Mercurous     Mercuric       Metallic     Antipyrine 

Oxide  Chloride      Mercury    Hydrochlor. 

As  but  a  small  proportion  of  the  calomel  is  converted  into 
corrosive  sublimate,  little  hesitancy  need  be  had  in  dispensing 
antipyrine  and  calomel,  when  the  latter  is  prescribed  in  small 
doses,  as  in  fractional  parts  of  a  grain.  (See  two  articles  on 
this  subject,  by  the  writer,  in  the  N.  Y.  Med.  Jour.  Vol.  LXIV, 
p.  752;  and  Vol.  LXV,  p.  223.)  I  now  consider  the  whole 
question  of  antipyrine  and  calomel  of  academic  interest  only. 
In  practice  I  do  not  hesitate  to  prescribe  them. 

38.  Plumbi  Acetatis|  .... 
Zinci  Sulph.       I""  ^J 

Div.  in  pulv.  No.  xii. 

If  the  two  ingredients  be  rubbed  together  in  a  mortar  a 
moist  mass  results,  due  to  chemical  interaction :  ZnS04  +  Pb 
(C2H302)2  =  Zn(C2H3O2)2  +  PbS04  and  the  consequent  lib- 
eration of  the  water  of  crystallization.  The  only  thing  to  do 
is  to  dispense  the  lead  acetate  and  the  zinc  sulphate  in  sep- 
arate, differently  colored  papers,  and  to  direct  the  patient  to 
dissolve  one  of  each  in  the  prescribed  amount  of  water. 


34  PRESCRIPTION  INCOMPATIBILITIES 

ZINC  SULPHATE  AND  LEAD  ACETATE  BECOME  DELIQUESCENT 
WHEN  RUBBED  TOGETHER. 

39.  Sodii  Salicyl 3  ij 

Syr.  Rub.  Idaei •_ I  ij 

Aquae  Gaultheriae B  *v 

Syrup  of  raspberry  contains  a  small  amount  of  citric  acid, 
which  will  decompose  a  small  quantity  of  the  salicylate  with 
the  formation  of  sodium  citrate  and  the  precipitation  of  sal- 
icylic acid.  As  the  quantity  is  very  small,  the  prescription 
may  be  dispensed  as  it  is,  or  it  may  be  filtered. 

40.  Quin.  Sulph >. .  3  i 

Acidi  Sulph.  Dil 3  ii 

Potass.  lodidi 3  v 

Syrupi   3  Jss 

Aquae ad  3  iv 

This  is  an  example  of  double  incompatibility.  The  sul- 
phuric acid  is  incompatible  with  potassium  iodide,  forming 
hydriodic  acid,  which  easily  decomposes,  iodine  being  set 
free ;  and  the  potassium  iodide,  with  the  free  iodine,  attacks 
the  quinine  sulphate,  precipitating  it  as  quinine  hydriodide 
(or  " iodide").  In  this  case  it  is  best  to  call  the  physician's 
attention  to  the  incompatibility.  If  he  insists  on  having  the 
quinine  and  the  iodide  in  the  same  mixture,  the  sulphuric 
acid  must  be  left  out ;  the  quinine  is  rubbed  up  with  a  por- 
tion of  the  water,  the  potassium  iodide  dissolved  in  the  re- 
mainder, this  solution  gradually  added  to  the  quinine  mix- 
ture, and  the  whole  dispensed  as  a  "shake"  mixture.  Only 
a  small  quantity  of  quinine  hydriodide  will  be  formed,  the 
solubility  of  quinine  sulphate  being  but  slight  (1  in  725). 

41.  Pancreatin   3  j 

Bism.  Subnitr 3  ss 

Sodii  Bicarbon 3  88 

Pulv.  Aromatici   gr.  xxiv 

Glycerini   3  ss 

ad      5  ii 


PRESCRIPTION  INCOMPATIBILITIES  35 

This  mixture  frequently  explodes,  especially  when  standing 
in  a  warm  place.  Occasionally  the  bottle  is  shattered  into 
numerous  bits.  The  reason  is  referable  to  the  liberation  of 
nitric  acid  from  the  bismuth  subnitrate,  which  in  its  turn  acts 
on  the  sodium  bicarbonate,  with  the  liberation  of  carbon  diox- 
ide. The  equation  may  be  expressed  as  follows : 

1.  2BIONOi  +  2H,0  =  BIONO,  +  Bi(OH),  +  HNO. 
Bismuth  Water         Bis.  Bis.  Nitric 
Subnitrate                    Subnitrate     Hydroxide     Acid 

2.  NaHCO.  +  HNO,  =  NaNO,  +  H,0  +  CO* 
Sod.  Nitric         Sod.        Water     Carbon 
Bicarb.         Acid          Nitrate  Diox. 

As  the  reactions  here  described  will  almost  invariably  take 
place  sooner  or  later,  the  physician's  attention  should  be 
called  to  the  fact,  and  the  suggestion  be  made  to  employ  the 
subcarbonate  instead  of  the  subnitrate  of  bismuth. 

42.  Strychn.  Snlphatis  gr.  ij 

Potass.  Bromidi 3  J 

Syrupi  3  iss 

Aquae  ad  3  VJ 

Potassium  bromide,  as  usually  found  on  the  markets,  is  in- 
compatible with  strychnine,  as  it  is  with  most  alkaloids,  pre- 
cipitating them  in  the  form  of  bromides.  Chemically  pure 
bromides  (and  iodides)  do  not  precipitate  the  alkaloids  as 
readily  as  do  the  commercial  articles.  The  latter,  in  order 
to  be  more  stable,  are  crystallized  from  alkaline  solutions,  and 
consequently  contain  some  hydroxide;  and  alkaline  hydrox- 
ides are  stronger  alkaloidal  precipitants  than  the  bromides 
or  iodides.  To  dispense  this  prescription  with  the  undissolved 
strychnine  bromide  would  be  manifestly  unsafe,  as  too  large 
a  dose  of  strychnine  may  be  poured  out  in  one  spoon. 

43.  Strychn.  Sulphatis  gr.  ij 

Potass.  Bromidi  3  J 

Syrupi 3  j 

Spir.  Frumenti %  ij 

Aquae   ad      J  vj 


36  PRESCRIPTION  INCOMPATIBILITIES 

This  prescription  may  be  dispensed,  as  the  alcohol  con- 
tained therein  is  sufficient  to  prevent  the  precipitation  of 
strychnine  bromide.  Strychnine  sulphate  and  potassium 
bromide  may  be  prescribed  together,  if  the  vehicle  contains 
from  twelve  to  fifteen  per  cent,  of  alcohol. 

44.  Stryehn.  Sulph &-  3 

Sodii  Phosphatis 3  J 

Magnes.  Sulph 3  J 

Aquae  3  viiJ 

S. :    %  ss  three  times  a  day. 

This  is  a  favorite  prescription  of  an  old  practitioner  for 
''catarrh,"  and  atony  of  the  stomach,  and  for  loss  of  appe- 
tite. The  dose  of  strychnine,  which  is  rather  large,  has  in 
no  instance  produced  any  bad  effects,  he  claims.  Sodium 
phosphate,  being  of  alkaline  reaction,  will  precipitate  the 
strychnine.  This  can  be  easily  prevented  by  adding  a  few 
drops  of  phosphoric  acid,  so  as  to  neutralize  the  alkalinity 
of  the  sodium  phosphate. 

45.  Argenti  Nitratis gr.  vj 

Ext.  Glycyrrhizae gr.  xij 

Pulv.  Althaeae q.s. 

M.  ft.  pil.  No.  xij. 

If  the  full  medicinal  virtues  of  the  silver  nitrate  are  to  be 
preserved,  it  should  not  be  prescribed  with  organic  matter, 
by  which  it  is  readily  decomposed.  Licorice  or  althea  should, 
therefore,  not  be  used  as  excipients  in  silver  nitrate  pills. 
Still  more  objectionable  is  an  excipient  prescribed  by  physi- 
cians of  the  old  school.  I  refer  to  "mica  panis,"  or  crumb 
of  bread.  Beside  being  organic  matter,  bread  contains  salt 
(sodium  chloride),  which  effectually  decomposes  the  nitrate, 
silver  chloride  resulting.  The  best  excipient  to  use  in  making 
these  pills  is  kaolin  or  argilla  alba  (which  is,  chemically,  a 
silicate  of  aluminum),  with  a  minute  quantity  of  anhydrous 
woolfat.  Instead  of  the  woolfat,  some  recommend  vaselin; 
but  the  latter  possesses  no  adhesive  properties,  and  it  is  diffi- 
cult to  make  a  presentable  pill  mass  with  kaolin  and  vaselin. 


PRESCRIPTION  INCOMPATIBILITIES  37 

SILVER  NITRATE  Is  INCOMPATIBLE  WITH  ORGANIC  SUB- 
STANCES. 

46.  Argenti  Nitratis gr.  x 

Acidi  Carbolic! gr.  vj 

Hydrastis  Aquosi 3  ss 

Glycerin!    5  ij 

Aquae  q.s.  ad     3  iy 

S. :     Use  as  an  injection. 

This  is  a  favorite  prescription  of  a  prominent  Brooklyn 
physician.  He  claims  he  gets  good  results  from  it,  but  it  is 
certainly  not  the  silver  nitrate  that  gives  the  good  results, 
as  there  is  no  nitrate  left  in  the  prescription;  it  becomes 
decomposed  by  the  organic  substances.  If  we  want  silver 
nitrate  in  solution  with  its  unimpaired  properties,  only  dis- 
tilled water  should  be  used,  nothing  else. 

47.  Argenti  Oxidi  gr.  x 

Ext.  Glycyrrhiz.  Pulv gr.  xv 

Glycerin!   q.s. 

M.  ft.  pil.  No.  xxx. 

Not  only  is  silver  oxide  incompatible  with  organic  matter, 
being  decomposed  by  it,  but  the  liberation  of  oxygen  may 
cause  a  miniature  explosion.  Perforating  the  lid  of  the  box 
or  dispensing  in  a  loosely  stoppered  vial  is  no  remedy,  be- 
cause in  being  evolved  from  the  pills,  the  gas  often  breaks 
the  pills  into  little  bits.  The  real  remedy  is  to  use  no  organic 
excipients,  only  kaolin  (with  a  bit  of  anhydrous  woolfat),  as 
recommended  for  pills  of  silver  nitrate. 

48.  Argenti  Nitratis   gr.  v 

Sodii  Chloiidi  gr.  x 

Aquae  Destillatae $  iv 

S. :     Use  an  injection. 

This  prescription  was  written  by  a  medical  practitioner  of 
the  Eclectic  School,  and  was  dispensed  by  a  druggist,  after 
having  been  filtered.  The  doctor  having  learned  that  the 
severe  burning  caused  by  silver  nitrate  can  be  effectually 


38  PRESCRIPTION  INCOMPATIBILITIES 

stopped  by  a  subsequent  injection  or  application  of  a  solu- 
tion of  sodium  chloride,  thought  he  would  simplify  matters 
and  save  time  and  labor  by  ordering  both  ingredients  in  the 
same  prescription.  That  there  was  no  silver  nitrate  left  in 
the  bottle,  need  not  be  dwelt  upon,  as  it  is  almost  presump- 
tion to  tell  intelligent  readers  that  sodium  chloride  decom- 
poses silver  nitrate  into  the  insoluble  and  inert  silver 
chloride. 
SILVER  NITRATE  Is  INCOMPATIBLE  WITH  SOLUBLE  CHLORIDES. 

49.  Bismuthi   Subnitr 3  ij 

Sodii  Bicarbon 5  i 

Mucil.  Acaciae   q.s. 

Div.  into  pil.  No.  xxiv. 

As  explained  in  Prescription  No.  41,  bismuth  subnitrate 
and  sodium  bicarbonate  are  somewhat  incompatible,  carbon 
dioxide  being  evolved.  These  pills  would  swell  and  break 
up.  This  may  be  avoided  by  using  the  subcarbonate  of  bis- 
muth instead  of  the  subnitrate,  or  by  using  an  excipient  prac- 
tically free  from  water,  such  as  glycerite  of  starch. 

50.  Acidi  Chromic!  3  ss 

Alcoholis   3  ij 

S. :    Use  externally. 

Of  all  the  oxidizing  official  chemicals,  such  as  potassium 
chlorate,  potassium  permanganate,  etc.,  chromic  acid  is  the 
most  so.  This  prescription  should  not  be  compounded  under 
any  circumstances.  Chromic  acid  should  never  be  brought  in 
contact  with  any  kind  of  organic  oxidizable  matter,  as  a 
dangerous  explosion  may  take  place.  Great  care  should  also 
be  taken  in  handling  it,  as  it  destroys  any  animal  tissue  with 
which  it  comes  in  contact. 

CHROMIC  ACID  (CHROMIUM  TRIOXIDE)  SHOULD  NEVER  BE 
PRESCRIBED  WITH  ORGANIC  SUBSTANCES. 

51.  Potass.  Pennangan gr.  x 

Glycerin!   3  j 

Aquae   ^  ij 

S. :    Use  externally. 


PRESCRIPTION  INCOMPATIBILITIES  39 

52.  Potass.  Permangan gr.  xxx 

Pulv.  Liquiritiae 

Ext.    Gentianae    aa  q.s. 

M.  ft.  massa  in  pilul.  No.  xxx  dividenda. 
The  remarks  made  regarding  silver  nitrate  are  applicable 
with  still  greater  force  to  potassium  permanganate.  The 
latter  is  exceedingly  sensitive  to  organic  matter ;  it  gives  off  its 
excess  value  as  an  oxidizer  with  the  utmost  readiness.  Its 
value  as  an  oxidizer  and  disinfectant  depends  upon  the  oxy- 
gen it  liberates  in  statu  nascendi.  It  is  self-evident,  there- 
fore, that  in  combining  it  with  organic  matter  (or  with  oxidiz- 
able  inorganic  matter)  its  usefulness  is  entirely  destroyed. 
When  ordered  in  solution,  it  should  be  prescribed  with  dis- 
tilled water  only.  For  pills,  kaolin  with  anhydrous  woolfat 
is  to  be  employed  as  the  excipient.  Or,  what  is  preferable, 
the  permanganate  is  intimately  mixed  with  kaolin  or  talcum 
and  filled  into  capsules  (dry).  It  is  also  worth  remembering 
that  when  a  solution  of  potassium  permanganate  is  used  exter- 
nally as  an  application,  a  considerable  portion  of  it  is  de- 
stroyed by  contact  with  the  cotton  swabs,  or  lint  employed  as 
a  dressing,  etc. 

53.  Pulv.  Calaminaris  i  _  -  r  . 
Zinci  Oxidi 

Acidi  Carbolic!  3  iv 

Aquae  Calcis •. 3  13 

Aquae  Rosae  q.s.  ad  3  iv 

Apply  frequently  and  freely. 

There  is  no  incompatibility  in  the  prescription,  but  it  is 
a  good  example  of  how  a  printer's  error,  combined  with 
ignorance  on  the  part  of  physician  and  druggist,  may  lead 
to  a  disastrous  accident.  I  was  asked  by  a  physician  to  see 
in  consultation  a  baby,  to  whom  he  had  the  day  before  pre- 
scribed the  above  lotion.  (The  child  had  an  eczematous  and 
urticarial  eruption.)  On  calling  the  next  morning,  the  child 
was  much  worse ;  it  had  screamed  badly  when  the  lotion  was 
applied,  refused  to  take  the  breast,  had  passed  no  water,  was 


40  PRESCRIPTION  INCOMPATIBILITIES 

very  restless;  in  short,  it  seemed  dangerously  ill.  By  the 
aid  of  a  catheter,  I  drew  off  some  urine,  which  was  of  a  green- 
ish color  and  highly  albuminous.  I  diagnosticated  carbolic 
acid  poisoning,  instituted  the  proper  treatment,  and  in  three 
days  the  child  was  well.  I  asked  him  what  he  had  pre- 
.  scribed ;  on  seeing  the  prescription,  I  told  him  that  the  car- 
bolic acid  was  excessive ;  that  this .  was  a  well-known  for- 
mula, but  that  %  dr.,  not  4  dr.  is  always  used  to  4  ozs.  He 
afterward  mailed  me  the  page  from  the  journal  from  which 
he  had  copied  the  formula,  and  indeed  the  formula  had  it 
y2  oz. !  Of  course,  both  the  physician  and  the  pharmacist  are 
to  blame  in  this  instance.  The  pharmacist  should  have  borne 
in  mind  that  half  an  ounce  of  carbolic  acid  cannot  be  dis- 
solved in  three  and  one-half  ounces  of  water,  and  that  it  is 
very  dangerous — in  fact,  it  is  absolutely  inadmissible — to 
dispense  a  mixture  with  carbolic  acid  held  in  suspension,  i.  e., 
not  in  perfect  solution. 

,54.    Zinci  Sulphatis  gr.  xxiv 

Plumbi  Acetatis    3  j 

Aquae    5  vi 

S. :    Use  externally  as  directed. 

Though  this  prescription  is  incompatible,  it  is  one  of  the 
most  common  examples  of  desirable  or  intentional  incom- 
patibility. Many  practitioners  stick  their  faith  to  the  above 
recipe,  considering  it  a  ne-plus-ultra  injection  in  gonorrhea ; 
and  there  seems  to  be  no  doubt  that  the  sulphate  of  lead 
exerts  a  beneficial  protective  influence  on  the  mucous  mem- 
brane of  the  urethral  canal,  while  the  zinc  acetate  has  a 
non-irritating  astringent  effect.  The  reaction  which  takes 
place  is  a  very  simple  one: 

ZnS04  +  PMCJLOO^ZntCrELO,),  +  PbSO* 

There  is  no  difficulty  in  making  up  this  prescription.  But 
how  often,  in  seeing  this  prescription  made,  was  I  able  to 
distinguish  between  the  good  pharmacist  and  the  bad  phar- 
macist. There  is  not  a  thing,  be  it  ever  so  small,  that  cannot 


PRESCRIPTION  INCOMPATIBILITIES  41 

be  done  either  rightly  or  wrongly.  An  ounce  of  zinc  oint- 
ment may  be  made  well  or  poorly.  The  careless  pharmacist, 
with  slipshod  methods,  with  no  love  for  his  profession,  will 
take  the  zinc  sulphate  and  the  lead  acetate  and  throw  them 
into  a  bottle,  which  he  will  then  fill  with  water  and  dispense, 
after  a  few  efforts  at  shaking.  This  will  make  a  lumpy  mix- 
ture, which  may  prove  quite  irritating.  The  real,  true  phar- 
macist, who  wants  to  prepare  this  prescription  lege  artis, 
will  proceed  as  follows:  He  will  boil  6  fl.  ozs.  of  distilled 
water  and  dissolve  the  zinc  sulphate  in  3  fl.  ozs.,  of  it,  and 
the  lead  acetate  in  the  remaining  3  fl.  ozs.  Should  the  solu- 
tion of  the  latter  be  somewhat  cloudy,  in  consequence  of  the 
exposure  of  the  lead  acetate  to  the  air  (lead  acetate  eagerly 
absorbs  carbon  dioxide,  forming  lead  carbonate),  he  will  add 
a  drop  or  two  of  acetic  acid ;  he  will  then  filter  the  solutions 
separately,  and  will  mix  the  filtrates  gradually,  under  con- 
stant agitation.  Prepared  in  this  manner,  the  lead  sulphate 
will  be  in  a  very  fine  state  of  subdivision.  "What  a  pity  that 
not  all  pharmacists  are  imbued  with  the  sacredness  of  their 
calling.  But  in  most  cases  it  is  thoughtlessness.  If  they  but 
knew  what  a  difference  it  may  make  in  the  results  of  treat- 
ment, they  would  devote  a  little  more  care  and  attention 
to  the  performance  of  their  professional  duties. 

55.     Hydrarg.  Chlor.  Corrosivi  gr.  vj 

Kali  lodati   3  ij 

Chinini  Mur - 3 .  ij 

Strych.  Sulph gr.  ij 

Tr.  Gentian.  Comp 3  J 

Syr.  Sarsap.  Comp %  ij 

Aquae    ad     3  vj 

This  prescription  belongs  to  a  class  which  is  unfortunately 
very  common.  The  physicians  of  the  younger  generation 
have  it  impressed  upon  their  minds  that  for  a  syphilitic  pa- 
tient tonic  treatment  is  just  as  important  as  the  specific  one. 
Consequently,  they  are  very  apt  to  attempt  to  combine  in 
one  mixture  the  mercurials  and  iodides  with  the  tonic  alka- 


42  PRESCRIPTION  INCOMPATIBILITIES 

loids.  Had  the  physician  tried  his  utmost  to  get  the  quinine 
and  the  strychnine  precipitated  he  could  not  have  done  any 
better  than  to  prescribe  them  with  corrosive  sublimate  and 
potassium  iodide.  Each  of  these  chemicals  alone  will  pre- 
cipitate alkaloids,  but  when  combined  they  form  the  so-called 
"Mayer's  solution  of  iodohydrargyrate  of  potassium,"  which 
is  one  of  the  most  potent  general  alkaloidal  precipitants. 
To  dispense  the  prescription  as  written  is  certainly  a  dan- 
gerous procedure,  as  the  patient  may  get  too  large  a  dose  of 
strychnine.  The  best  thing  is  to  communicate  with  the  physi- 
cian. If  this  is  not  feasible,  I  would  leave  out  the  strychnine 
on  my  own  responsibility,  and  impress  upon  the  patient  the 
importance  of  shaking  the  bottle  each  time ;  and  I  would  in- 
form the  physician  by  mail,  so  that  he  can  order  the  strych- 
nine separately,  in  the  form  of  pills  or  tablets. 

ALKALOIDS  SHOULD  NEVER  BE  PRESCRIBED  IN  A  MIXTURE 
CONTAINING  MERCURIC  CHLORIDE  AND  POTASSIUM  IODIDE. 
THERE  Is  SURE  TO  BE  A  MUTUAL  PRECIPITATION. 

56.  Hydrarg.  Bichlor 0.12 

Potass.   lodidi    10.0 

Tr.  Cinchon.  Comp 60.0 

Syr.  Sarsap.  Comp 15.0 

Aquae    q.s.  ad  120.0 

The  remarks  made  in  the  preceding  prescription  apply  te 
this  one  as  well,  except,  of  course,  that  there  are  no  poison- 
ous alkaloids.  The  bichloride  and  the  iodide  will  precipitate 
the  alkaloids  of  the  cinchona.  The  bichloride  will  also  be 
affected  by  the  tannic  acid  in  the  cinchona.  (Corrosive  sub- 
limate is  a  very  delicate  agent,  and  should  be  prescribed  as 
little  in  combination  as  possible.)  But,  as  many  physicians 
insist  on  prescribing  the  above  mixture,  it  should  be  dis- 
pensed with  a  "shake"  label. 

57.  Tr.  Ferri.  Mur 10.0 

Tr.  Chinae  100.0 

This  is  a  favorite  prescription  with  many  German  prac- 


PRESCRIPTION  INCOMPATIBILITIES  43 

titioners,  and  is  known  in  some  drug  stores  by  the  name 
"German  ink."  The  cincho-tannic  acid  combines  with  the 
iron,  producing  tannate  of  iron,  yielding  a  greenish-black, 
inky  mixture.  But  as  the  physicians  prescribing  it  are  aware 
of  the  change  of  color  in  this  mixture,  and  do  not  mind  it, 
the  pharmacist  must  not  interfere.  After  all,  appearance  is 
not  everything;  and,  as  some  one  has  said,  "a  nasty  medicine 
is  preferable  to  a  nice  funeral." 

58.  Quin.  Sulph 3  i 

Acidi  Sulph.  Dil q.s. 

Ext.  Glycyrrhiz.  Fl 3  ss 

Syrupi    3  i 

Aquae    ad  3  i" 

This  is  an  old  and  well-known  prescription  incompatibility. 
The  dilute  sulphuric  acid  works  double  mischief.  First,  by 
dissolving  the  quinine,  it  renders  the  mixture  intensely  bit- 
ter; secondly,  by  precipitating  the  glycyrrhizin  from  the 
fluidextract  of  glycyrrhiza,  the  sweetening  or  disguising 
property  of  the  latter  is  completely  destroyed.  Omit  the  sul- 
phuric acid,  and  dispense  the  prescription  as  a  "shake" 
mixture. 

59.  Sol.  Magendie  3  ii 

Sol.  Potass.  lodidi  Satur 3  vi 

S.:     Gtt.  x  t.i.d.  p.c. 

The  pharmacist  should  refuse  to  dispense  this  prescription. 
While  the  dispensing  of  a  non-poisonous  alkaloid  like  quinine 
in  an  undissolved  form  is  more  a  matter  of  esthetics  than 
anything  else,  it  is  entirely  different  when  we  have  poisonous 
principles  to  deal  with.  Poisonous  alkaloids  are  to  be  dis- 
pensed in  liquid  mixtures  only  when  they  are  in  perfect 
solution  and  when  there  is  no  danger  of  their  subsequent 
precipitation.  Within  a  very  short  time,  silky  needles  will 
begin  to  deposit,  and  eventually  all  the  morphine  will  be 
precipitated  out  as  morphine  hydriodide.  That  it  would  be 
a  very  dangerous  thing  to  take  this  medicine  by  drops,  re- 
quires no  argument. 


44  PRESCRIPTION  INCOMPATIBILITIES 

GO.    Potass.  Chloratis  3  iss 

Acidi  Hydrochlor 3  i 

Glycerin!    %  i 

Aquae    ad  3  *v 

S. :    As  directed,  on  a  cotton  swab. 

The  making  up  of  this  prescription  will  depend  greatly  on 
the  physician's  directions  and  on  the  knowledge  as  to  how 
it  is  to  be  employed.  When  prescribed  in  diphtheria,  to  be 
used  for  swabbing  the  throat,  the  physician  generally  wants 
the  solution  to  contain  free  chlorine.  In  this  case,  the  pre- 
scription is  compounded  just  as  written;  i.  e.,  the  hydro- 
chloric acid  is  poured  directly  on  the  potassium  chlorate 
(crystals).  This  generates  free  chlorine.  When  the  reac- 
tion seems  to  be  completed,  the  water  is  added,  and  then 
the  glycerin.  However,  if  wanted  for  internal  use,  or  when 
the  evolution  of  chlorine  is  not  desired,  the  potassium  chlorate 
should  be  dissolved  in  the  water  and  mixed  with  the  glycerin, 
and  then  the  hydrochloric  acid  should  be  added  last.  If 
made  in  this  manner,  no  chlorine  will  be  evolved. 

61.    Potass.  Chloratis  3  i 

Tr.  Ferri  Chloridi  3  i 

Glycerini    3  i 

Aquae    ad  \  vi 

S.:    I  ss  as  directed. 

I  used  to  dispense  this  prescription  daily,  and  several 
times  a  day,  because  I  knew  how  it  was  to  be  employed;  a 
tablespoonful  was  to  be  mixed  with  a  cupful  of  warm  water 
and  used  as  gargle.  But  should  the  directions  not  be  known, 
the  prescription  should  not  be  dispensed.  Were  the  dose 
even  a  teaspoon  instead  of  a  tablespoon,  I  would  hardly  dis- 
pense it;  not  because  the  dose  (ten  grains)  of  potassium 
chlorate  would  be  an  excessive  one — it  is  rather  large,  and 
physicians  are  of  late  very  cautious  in  administering  large 
doses  of  KC103— but  because  the  chemical  is  not  dissolved; 
and  undissolved,  potassium  chlorate  is  extremely  irritating 
to  the  throat  and  stomach.  But  where  the  physician  is 


PRESCRIPTION  INCOMPATIBILITIES  45 

of  the  circumstances  and  insists  on  the  prescription  being 
dispensed  as  written,  the  druggist  has  no  alternative  but  to 
obey. 

62.  Calomelanos  gr.  v 

Potass.  Bromidi   gr.  v 

Sacch.  Lactis    gr.  v 

Ft.  tal.  doses  No.  xxx. 

This  prescription  is  a  dangerous  one,  and  should  not  be 
dispensed  under  any  circumstances.  A  reaction  takes  place 
between  the  mercurous  chloride  and  potassium  bromide,  with 
the  formation  of  mercuric  bromide,  a  very  poisonous  com- 
pound. The  equation  is  as  follows: 

2HgCl  +  4KBr  =  Hg  +  HgBn  +  2KBR  +  2KC1 
Calomel     Potass.     Mer-     Mercuric  Potass.       Potass. 
Bromide  cury     Bromide    Bromide    Chloride 

The  presence  of  water  or  moisture  seems  to  be  necessary 
for  the  reaction  to  take  place,  because  if  the  potassium 
bromide  is  dried,  so  that  all  interstitial  moisture  is  driven 
off,  no  change  occurs  in  the  mixture.  The  reaction  occurs 
immediately,  however,  on  the  addition  of  water  (which  is 
present  also  in  the  gastric  juice).  Even  when  administered 
separately,  calomel  and  potassium  bromide  should  not  be 
given  at  too  short  intervals  apart ;  a  period  of  one  or  two 
hours  should  intervene,  so  as  to  avoid  the  possible  danger 
of  the  formation  of  mercuric  bromide  in  the  stomach. 

63.  Sol.  Natrii  Bicarbon.,  25%   5  vii j 

S. :     Apply  externally  all  over  the  body,  with  a*  piece  of 

cotton. 

This  is  a  short  prescription,  but  a  very  interesting  tale 
goes  with  it.  It  was  presented  to  me  in  my  early  junior 
days.  One  of  the  first  things  I  committed  to  memory — and 
I  would  recommend  all  drug-clerks  to  do  the  same — was  the 
solubility  of  the  commonly  employed  chemicals.  I,  therefore, 
saw  at  once  that  there  was  no  possibility  of  making  a  twenty- 
five  per  cent,  solution  of  sodium  bicarbonate,  and  so  told 


46  PRESCRIPTION  INCOMPATIBILITIES 

the  proprietor;  the  strongest  solution  that  can  be  made  is 
about  eight  per  cent. 

"Well,"  said  he,  "you  have  not  had  very  much  experience, 
I  see;  I'll  make  the  solution  all  right."  He  then  weighed 
out  two  ounces  of  sodium  bicarbonate,  took  eight  ounces  of 
water  (the  right  quantity  would  have  been  six  ounces),  put 
both  in  a  dish,  and  brought  the  solution  to  boiling.  A  clear 
solution  resulted.  "But  won't  it  precipitate  on  cooling?" 
remonstrated  I,  mildly.  "Wait  and  see."  The  solution  be- 
came cold  and  remained  perfectly  clear.  With  a  look  of 
triumph,  the  "boss"  delivered  it,  and  very  satisfied  was  he. 
However,  the  next  morning  the  doctor  who  prescribed  the 
solution  came  to  the  store  in  a  perfect  rage.  We  must  have 
made  a  mistake,  a  terrible  mistake ;  we  must  have  put  in 
some  poisonous  stuff,  some  caustic ;  it  nearly  killed  the  baby  ; 
the  eruption  became  much  worse ;  the  itching  was  intolerable, 
etc.,  etc. 

Now,  what  had  taken  place?  Simply  this:  Any  bicar- 
bonate in  solution,  when  strongly  heated  or  boiled,  becomes 
converted  into  a  carbonate,  according  to  the  following  equa- 
tion: 

2NaHCO»  +  heat  =  NaaCO.  +  C0»  +  ILO. 

The  solution  delivered  was  consequently  not  one  of  sodium 
bicarbonate,  but  a  strong  solution  of  sodium  carbonate.  It 
was  to  be  applied  to  a  little  baby  that  had  a  slight  eruption. 
No  wonder  that  it  produced  such  great  injury !  The  child 's 
suffering  coujd  be  allayed  only  by  wrapping  the  whole  body 
in  lint  soaked  in  carron  oil ;  and  it  took  quite  a  long  while 
before  it  got  well.  My  proprietor  never  afterward  dispensed 
a  twenty-five  per  cent,  solution  of  sodium  bicarbonate. 

64.     Tr.  Ferri  Chlor 3  ij 

Glycerin!   5  ss 

Aquae  Gaultheriae  3-  jjj 

What  will  take  place  in  this  prescription?  It  assumes  a 
beautiful  violet-blue  color.  What  is  this  due  to?  Oil  of  win- 


PRESCRIPTION  INCOMPATIBILITIES  47 

tergreen  consists  principally  of  methyl  salicylate,  and  all 
salicylates  are  incompatible  with  ferric  salts,  forming  ferric 
salicylate,  which  is  of  a  deep  violet-blue  color.  The  reac- 
tion is  explained  by  the  following  equation : 

2FeCl,  +  6CILCMLO.  =  Fe^aiLOa).  +  6CH.C1. 

While  some  physicians  may  prescribe  it,  being  unfamiliar 
with  the  facts,  I  knew  one  physician  who  used  to  prescribe 
this  mixture  purposely,  in  order  not  to  let  his  patients  know 
that  they  were  taking  iron. 

65.  Tr.  Ferri  Chloridi  3  ij 

Kali  Chloratis  3  j 

Antipyrini    q.s. 

Glycerini   I  j 

Aquae    ad  5  ii j 

The  "antipyrini,  q.  s.,"  shows  that  the  physician  wants 
the  antipyrin  only  for  the  color  it  produces  with  the  iron. 
As  the  "yellow  throat  mixture"  is  too  well  known,  some 
physicians  prefer  to  make  their  patients  believe  that  they 
are  taking  something  new.  Antipyrin  produces  a  deep-red 
color  with  ferric  salts. 

66.  Natrii  Salicyl 3  ss 

Spir.  Nit.  Dulcis   5  j 

Syr.  Simpl 3  J 

Aquae    ad  3  viij 

When  dispensed  this  is  a  perfectly  clear  solution,  but  grad- 
ually it  begins  to  darken  until  it  is  almost  black.  This  dark- 
ening is  due  to  a  reaction  between  the  sodium  salicylate  and 
the  spirit  of  nitrous  ether.  The  patient  is  likely  to  bring 
back  the  mixture,  asking  if  a  mistake  had  not  been  made,  or 
if  it  did  not  get  spoiled.  It  is  therefore  imperative  to  in- 
form the  patient  that  this  mixture  will  get  dark ;  he  will  then 
not  be  alarmed.  The  exact  nature  of  the  reaction  between 
the  salicylate  and  the  nitrous  ether,  as  between  antipyrin 
and  nitrous  ether,  and  many  other  organic  compounds,  is 
not  well  understood.  I  will  remark  here  that  where  no  de- 


48  PRESCRIPTION  INCOMPATIBILITIES 

tails  are  given  as  to  the  reaction  which  takes  place,  it  is  be- 
cause no  definite  statement  can  be  made.  To  go  into  specula- 
tion would  lead  us  too  far  and  would  hardly  prove  very 
useful  to  the  reader. 

67.  Ammon.  Carbon 3  ij 

Syr.  Ipecac 3  ij 

Syr.  Scillae  3  ss 

Syr.  Prun.  Virgin 3  J 

Aquae    ad  3  "j 

S.:    3  i  q.  3  h.  until  cough  is  relieved. 

The  acetic  acid  present  in  both  the  syrup  of  squill  and 
the  syrup  of  ipecac  will  decompose  the  ammonium  carbonate, 
producing  ammonium  acetate  and  carbon  dioxide.  The  mix- 
ture should,  therefore,  be  made  in  a  mortar,  and  poured  into 
the  bottle  only  after  the  evolution  of  C02  has  ceased. 

ACIDS  LIBERATE  CARBON  DIOXIDE  FROM  CARBONATES. 

68.  Liq.  Plumbi  Subacet 3  ij 

Mucil.  Acaciae 3  *v 

Aquae   ad  3  xvj 

S. :    Dip  a  cloth  and  keep  constantly  wet. 

Solution  of  lead  subacetate  forms  such  a  thick,  gelatinous 
mass  with  mucilage  of  acacia  that  a  cloth  cannot  be  dipped 
into  it  or  kept  constantly  moist  with  it.  Two  ways  are  open : 
either  to  leave  the  mucilage  out,  or,  better,  to  substitute  lead 
acetate  for  lead  subacetate,  as  lead  acetate  gives  no  pre- 
cipitate with  mucilage  of  acacia.  Liq.  Plumbi  Subacet.  being 
about  25  per  cent,  strong  the  proper  quantity  of  lead  acetate 
would  be  about  half  an  ounce. 

SOLUTION  OP  LEAD  SUBACETATE  GIVES  A  THICK  GELATINOUS 
PRECIPITATE  WITH  MUCILAGE  OP  ACACIA. 

68.    Acidi  Salicylici 3  ij 

Natrii  Bicarb 3  jss 

Syr.  Aurantii  Cort 5  j 

Aquae  Menthae   q.a.  ad  I  vj 

According  to  the  books,  an  acid  and  an  alkali  are  incom- 


PRESCRIPTION  INCOMPATIBILITIES  49 

patible,  but  this  is  a  kind  of  incompatibility  that  physicians 
would  do  well  to  practice  more  than  they  do.     The  salicylic 
acid  and  the  sodium  bicarbonate  react  with  one  another,  and 
the  freshly  formed  sodium  salicylate  is  the  result,  thus: 
NaHCO.  +  HCtH.O,  =  NaCiH.Oi  +  CO,  +  ILO. 

The  proper  way  is  to  dissolve  the  NaHC03  in  the  water  in 
a  mortar,  add  the  salicylic  acid,  stirring  until  dissolved,  fil- 
tering rapidly,  adding  the  syrup  and  waiting  until  all  the 
C02  is  expelled  before  bottling.  Many  practitioners  believe 
that  this  freshly  prepared  salicylate  is  superior  to  the  ready 
made  article.  That  it  is  more  acceptable  to  the  stomach  is 
a  fact. 

70.     Acidi  Salicylic!  3  v 

Natrii  Bicarb q.s.  ad  saturationem 

Syr.  Rub.  Idaei   I  j 

Aquae  Gaultheriae  %  viij 

The  physician  desires  the  apothecary  to  supply  the  neces- 
sary quantity  of  sodium  bicarbonate  to  neutralize  the  sali- 
cylic acid.  It  cannot  be  expected  that  a  physician  should 
know  the  proper  quantities  of  alkalies  required  to  neutralize 
certain  quantities  of  acids  and  vice  versa,  but  the  pharma- 
cist should  know  it ;  it  is  his  business  to  know  such  things, 
and  such  questions  should  be  met  with  frequently  in  our 
Board  of  Pharmacy  examinations.  Unfortunately,  there  are 
many  druggists  to  whom  such  problems  are  about  as  intelli- 
gible as  Chinese  is.  They  are  not  aware  even  of  the  fact 
that  at  the  end  of  the  Pharmacopeia  there  are  tables  which 
give  the  exact  quantities  of  acids  and  alkalies  required  for 
mutual  neutralization.  Until  our  examinations  become  more 
practical  and  more  stringent,  such  state  of  affairs  will  con- 
tinue to  exist.  One  hundred  parts  of  salicylic  acid  require 
for  complete  neutralization  62  parts  of  sodium  bicarbonate; 
for  practical  purposes  it  is  enough  to  remember  the  propor- 
tion of  5  to  3.  Consequently,  5  dr.  of  salicylic  will  require 
3  dr.  (more  exactly  3  dr.  and  6  grn.)  of  sodium  bicarbonate. 


50  PRESCRIPTION  INCOMPATIBILITIES 

The  order  of  procedure  is  the  same  as  in  the  previous  pre- 
scription. 

71.     Extr.  Uvae  Ursi  Fl I  ss 

Spt.  Aetheris  Nitrosi  3  J 

Spt.  Juniper!  Comp. 

Ext.  Tritici  Fl aa  5  ij 

Syrupi  Simplicis  et  Aquae  aa ad  3  iv 

I  know  a  druggist  whom  the  improper  putting  up  of  this 
prescription  cost  the  price  of  a  pair  of  trousers.  The  cus- 
tomer put  the  bottle  in  his  pocket,  but  returned  in  a  minute 
with  the  dark  liquid  trickling  down  his  white  trousers,  and 
full  of  angry  words  at  the  druggist  for  his  carelessness  in 
not  corking  the  bottle  properly,  etc.  The  druggist  denied  the 
allegation,  and  said  it  must  have  been  the  man's  own  fault, 
but  agreed  to  make  up  another  bottle  without  extra  charge. 
Unfortunately,  while  handling  this  second  bottle,  the  cork 
popped  out  with  quite  an  explosion,  striking  the  man's  fade 
with  considerable  force,  bespattering  his  white  front,  etc. 
To  avoid  any  scenes,  and  to  get  rid  of  the  man  before  the 
return  of  the  boss,  the  poor  drug  clerk  agreed  to  "settle" 
with  the  man  and  return  him  the  prescription. 

I  once  experimented  with  a  similar  mixture  to  see  how 
long  the  evolution  of  the  gas  would  last.  Fourteen  times, 
at  gradually  increasing  intervals,  the  cork  popped  out.  The 
fifteenth  time  it  stayed  in.  The  gas  which  is  evolved  con- 
sists of  various  oxides  of  nitrogen.  The  statement  is  gen- 
erally made  that  this  evolution  of  gas  is  due  to  the  action 
of  the  nitrous  acid  on  the  tannic  acid  of  the  uva  ursi.  It 
is  true  uva  ursi  contains  a  very  large  percentage  of  tannic 
acid,  but  the  latter  must  differ  somewhat  in  its  properties 
from  the  ordinary  tannic  acid,  or  there  must  be  another  con- 
stituent co-active  in  the  reaction.  I  am  impelled  to  this  belief 
by  the  fact  that  when  spirit  of  nitrous  ether  is  mixed  with 
tannic  acid,  the  volume  of  gas  evolved  is  very  insignificant; 
there  is  a  red  color  produced,  due  most  probably  to  the 
formation  of  a  small  quantity  of  nitrogen  tetroxide,  but 


PRESCRIPTION  INCOMPATIBILITIES  51 

hardly  ever  is  there  sufficient  gas  to  expel  the  cork.  The 
ingredients  should  be  mixed  in  a  large  graduate  or  mortar; 
ample  time  should  be  allowed  for  the  evolution  of  gas  to 
cease,  and  after  the  bottle  is  corked  enough  time  should  elapse 
before  delivering  it,  to  make  sure  that  the  cork  will  not  come 
out  (or  it  may  be  tied  with  a  string).  The  nitrous  ether 
is  completely  spoiled,  decomposed,  in  this  prescription,  and 
might  as  well  have  been  left  out  by  the  physician. 

72.  Fluid  Ext.  Buchu 
Spt.  Aetheris  Nitrosi 

Spt.  Jump.  Comp aa  30.0 

Syr.  Rub.  Idaei  15.0 

Aquae   60.0 

A  reaction  similar  to  the  one  in  the  preceding  prescription 
takes  place  in  this,  i.  e.,  there  is  evolution  of  gas,  liability  to 
explosion,  etc.  The  same  remarks  about  dispensing  apply 
to  this  one. 

73.  Potass.  lodidi    3  ij 

Syr.  Ferri  lodidi 3  ijss 

Aquae   3  jss 

I  prescribe  this  combination  very  frequently,  and  some- 
times I  will  find  a  precipitate  and  sometimes  not.  If  chem- 
ically pure  potassium  iodide  be  used,  no  precipitation  will 
take  place.  Commercial  KI  is  crystallized  from  a  solution  of 
potash  (which  gives  it  better  keeping  qualities)  and  con- 
tains, besides,  as  an  impurity,  a  small  amount  of  potassium 
carbonate.  It  is  the  hydroxide  (with  the  carbonate)  which 
produces  a  precipitate  of  ferrous  hydroxide.  In  cases  where 
no  precipitate  is  found,  it  is  probably  due  to  one  of  two 
causes ;  either  it  is  filtered  out,  or  the  syrup  of  iodide  of 
iron  was  not  made  properly,  and  contained  an  appreciable 
quantity  of  free  iodine;  the  latter  combined  with  the  KOH, 
and  thus  prevented  precipitation.  In  no  case  was  it  referable 
to  the  employment  of  chemically  pure  KI,  as  none  of  the 
druggists  kept  this  in  stock;  it  is  prone  to  liberate  iodine  and 
become  discolored. 


52  PRESCRIPTION  INCOMPATIBILITIES 

74.  Acidi  Phenylici  3  ij 

Collodii  5  VJ 

S.:    Apply  with  camel's-hair  brush  night  and  morning. 

When  carbolic  acid  is  added  to  collodion,  a  coagulated  mass 
forms,  which  cannot  be  applied  with  a  brush.  Besides,  the 
property  of  the  collodion  becomes  changed ;  i.  e.,  the  collodion 
becomes  useless  as  such.  The  physician's  attention  should 
be  called  to  these  facts,  and  the  suggestion  made  to  him  to 
employ  creosote  instead  of  phenol.  Creosote  forms  a  clear 
solution  with  collodion. 

CARBOLIC  ACID  Is  INCOMPATIBLE  WITH  COLLODION:  A  CO- 
AGULATED MASS  Is  FORMED. 

75.  Hydrargyri  Chlor.  Corros gr.  vj 

Aquae  Calcis 5  iv 

Aquae  Plumbi 

Aquae  Destill aa  I  ii 

S. :    Poison!    For  external  use  only. 

This  prescription  admirably  serves  to  illustrate  what  dif- 
ferent results  we  may  obtain  in  some  instances  by  a  different 
order  of  mixing  the  ingredients,  and  how  absolutely  neces- 
sary it  is,  therefore,  to  take  note  of  the  exact  order  observed. 
If  the  solution  of  corrosive  sublimate  be  poured  into  the  lime 
water,  yellow  mercuric  oxide  will  be  formed;  if  the  lime 
water  be  poured  into  the  solution  of  the  corrosive  sublimate, 
brown  mercuric  oxychloride  will  precipitate.  The  subse- 
quent addition  of  the  lead  water  to  this  mixture  will  not 
change  the  result,  and  the  patient  will  receive  a  shake  mix- 
ture with  a  yellow  or  brown  precipitate.  If,  on  the  other 
hand,  the  mercuric  chloride  solution  is  added  at  once  to 
the  lead  water,  a  milky  white  homogeneous  mixture  is  ob- 
tained, which  remains  unchanged  by  the  subsequent  addi- 
tion of  the  lime  water.  As  to  the  exact  chemical  composi- 
tion of  this  precipitate,  my  impression  is  that  it  is  a  basic 
acetate  of  mercury,  together  with  some  lead  chloride;  it  is 
also  possible  that  a  double  compound  of  mercury  and  lead 


PRESCRIPTION  INCOMPATIBILITIES        53 

is  formed.  For  practical  purposes  it  is  sufficient  to  know 
that  the  reaction  does  not  take  place  with  the  neutral  lead 
acetate. 

I  have  also  seen  this  prescription  dispensed  as  a  perfectly 
clear,  colorless  solution.  On  investigating  the  following  cause 
was  discovered :  Some  druggists  invariably  add  to  their 
liquor  plumbi  subacetatis  a  little  acetic  acid  for  the  intended 
purpose  of  preventing  its  becoming  turbid  on  exposure  or  on 
being  mixed  with  plain  water.  That  they  thus  destroy  all 
their  work  and  convert  the  basic  acetate  into  a  normal  one 
does  not  enter  their  minds.  At  any  rate,  when  the  mercuric 
chlorid  is  mixed  with  such  a  lead  water  no  precipitation 
will  take  place  nor  will  there  be  any  reaction  on  the  addi- 
tion of  the  lime  water.  The  mercuric  chloride  will  re"main 
unimpaired  and  unchanged;  but  we  must  not  forget  that 
instead  of  lead  subacetate  we  have  lead  acetate,  and  in- 
stead of  calcium  hydroxide  we  have  calcium  acetate. 

76.  Sol.  Hydrarg.  Perchlor.  Sat 3  j 

Aquae  Calcis  3  v 

Mucil.  Acaciae    3  3 

Here  is  another  example  where  the  order  of  mixing  the 
ingredients  controls  the  results.  If  the  solution  of  the  cor- 
rosive sublimate  is  poured  into  the  lime  water,  yellow  mer- 
curic oxide  is  formed ;  if  the  lime  water  is  added  to  the 
solution  of  the  bichloride,  the  reddish-brown  oxychloride  of 
mercury  precipitates.  If  the  corrosive-sublimate  solution  is 
mixed  with  the  mucilage  of  acacia  and  then  with  the  lime 
water,  precipitation  will  be  prevented  altogether  or  for  sev- 
eral days  at  any  rate.  The  mucilage  of  acacia  must  be  the 
true  U.  S.  P.  mucilage  and  not  one  of  those  dark,  almost 
black,  sour-smelling  products  which  pass  for  mucilage  of 
acacia  in  some  drug-stores. 

77.  Sol.  Kalii  Arsenicosi 10.0 

Argenti  Nitrici   0.5 

Syr.  Sacchari 25.0 

Aquae  Menthae 125.0 


54  PRESCRIPTION  INCOMPATIBILITIES 

This  prescription  presents  a  triple  incompatibility.  The 
potassium  carbonate  present  in  Fowler's  solution  will  precip- 
itate the  silver  as  silver  carbonate ;  another  portion  of  the 
silver  will  combine  with  the  arsenite,  precipitating  it  as  the 
bright-yellow  silver  arsenite ;  and  lastly  the  silver  nitrate 
is  incompatible  with  the  sugar  of  the  syrup  and  with  the 
peppermint  water.  As  the  prescription  stands  it  should  not 
be  dispensed ;  but  it  can  be  made  dispensable.  By  acidifying 
the  Fowler 's  solution  two  objects  are  gained :  The  potassium 
carbonate  is  neutralized,  and  thereby  precipitation  of  the 
silver  arsenite  is  prevented  (the  latter  does  not  take  place 
in  an  acid  solution).  When  Fowler's  solution  is  acidified  for 
combination  with  alkaloidal  salts,  etc.,  hydrochloric  acid  is 
usually  employed.  In  the  present  case  HC1  cannot  be  used, 
as  it  would  precipitate  the  entire  amount  of  silver  as  silver 
chloride;  the  most  eligible  acid  in  this  case  is  nitric  acid. 
The  simple  syrup  should  be  left  out  altogether ;  and  instead 
of  peppermint  water  distilled  water  should  be  used.  The 
compound  tincture  of  lavender  of  the  arsenical  solution  would 
also  tend  to  decompose  the  silver  nitrate.  As  there  are  so 
many  radical  changes  necessary,  it  is  best  to  consult  the 
physician. 

78.     Tr.  Strophanthi  3  i 

Spirit.  Mindereri 5  iv 

Tr.  Ferri  Chloridi 3  i 

Glycerin!   3  j 

Aquae q.s.   ad  3  viij 

S.:     3  ss  three  times  a  day. 

This  prescription  was  received  with  a  query  as  to  what 
the  brown  precipitate  was  due  to  and  whether  it  could  be 
prevented.  The  cause  of  the  precipitation  is  this:  Solution 
of  the  ammonium  acetate  is  frequently  alkaline;  that  is, 
it  contains  some  ammonium  carbonate  which  has  not  been 
neutralized.  This  later  produces  a  precipitate  of  ferric 
oxide.  To  avoid  this  a  little  extra  acetic  acid  should  be 
added  to  the  spirit  of  Mindererus  (as  the  U.  S.  P.  directs), 


PRESCRIPTION  INCOMPATIBILITIES  55 

to  make  sure  that  it  is  acid,  and  then  only  mix  it  with  the 
tincture  of  iron.  When  thus  made  a  clear,  transparent, 
bright-red  solution  is  the  result.  The  bright-red  color  is  due 
to  the  ferric  acetate  formed,  according  to  the  following  equa- 
tion: 


Fed,  +  3NH4C,H.O.  =  Fe(C.H,0,)»+  3NILC1. 

The  Pharmacopeia  directs  Basham's  mixture  to  be  made 
fresh  when  wanted  for  use;  and  in  examinations  the  ques- 
tion frequently  occurs  :  "Is  Basham  's  mixture  a  stable  prep- 
aration?" and  the  candidate  is  expected  to  answer  that  it  is 
unstable.  Accepting  the  term  "stable"  in  its  ordinary  inter- 
pretation, the  writer  wishes  to  take  issue  with  the  examiners, 
and  say  that,  if  properly  made,  Liquor  Ferri  et  Ammonii 
Acetatis,  U.  S.  P.  IX,  is  quite  a  stable  solution.  He  made 
observations  on  several  samples,  and  in  three  or  four  weeks 
no  trace  of  decomposition  was  discoverable.  The  explana- 
tion of  the  assertion  that  t"he  solution  in  question  is  very 
unstable  is  perhaps  to  be  found  in  the  fact  that  Basham's 
mixture  made  according  to  the  old  pharmacopeias  was  quite 
unstable,  as  it  contained  no  protective  agent  such  as  is  called 
for  in  the  present  formula,  i.  e.,  glycerin. 

79.     Liq.  Potassi  Arsenitis  ........................  3  ij 

Ferri  Dialysati  ..............................  5  ij 

Aquae  Anisi  ................................  3  ij 

This  is  an  example  of  double  incompatibility.  The  potas- 
sium carbonate  in  the  Fowler's  solution  will  precipitate  fer- 
ric carbonate,  which  is  almost  immediately  converted  into 
ferric  hydroxide.  This  with  the  potassium  arsenite  forms 
a  basic  ferric  arsenite  which  precipitates.  It  will  be  re- 
membered that  freshly  prepared  ferric  hydroxide  is  the  offi- 
cial antidote  for  arsenical  poisoning,  because  it  combines 
with  the  arsenic  preparations,  forming  insoluble  arsenites 
and  arsenates.  It  sometimes  happens  that  no  precipitation 
takes  place.  If  this  is  the  case,  it  may  be  assumed  that  .the 


56  PRESCRIPTION  INCOMPATIBILITIES 

dialyzed  iron  has  not  been  properly  made,  i.  e.,  that  it  con- 
tains free  acid.  The  free  acid  neutralizes  the  alkali  in  Fow- 
ler's solution,  forming  potassium  chloride,  and  preventing 
precipitation.  Dialyzed  iron,  when  properly  and  conscien- 
tiously made,  is  neutral.  The  way  to  make  up  this  prescrip- 
tion is  to  neutralize  the  Fowler's  solution  with  a  few  drops 
of  hydrochloric  acid  (or  to  take  Liquor  Acidi  Arsenosi  in- 
stead), add  it  to  the  anise  water  and  the  mixture  to  the 
dialyzed  iron. 

80.    Pepsini  Puri  3  ij 

Acidi  Hydrochlor.  Dil 3  ij 

Bism.  et  Ammon.  Citratis 3  iij 

Syrupi  Aurantii  5  J 

Aquae  Menthae  ad  3  iv 

S.:    3  j  t.i.d.,  in  Vino  Xerico. 

The  existence  of  bismuth  and  ammonium  citrate  in  the 
United  States  and  British  Pharmacopoeias  is  a  good  example 
of  misplaced  zeal  and  misdirected  energy.  It,  as  well  as  bis- 
muth citrate,  should  be  dropped  from  the  next  revision. 
There  is  not  a  single  disease  of  the  gastro-intestinal  canal 
where  the  insoluble  salts  of  bismuth — the  subnitrate  and 
the  subcarbonate — do  not  act  better  than  this  soluble  salt. 
In  many  conditions — such  as  ulcer  of  the  stomach,  ulcera- 
tion  and  inflammation  of  the  bowels — the  bismuth  subni- 
trate, subcarbonate,  etc.,  act  well  just  because  of  their  insol- 
ubility; i.  e.,  they  form  a  protective  coating  to  the  mucous 
membrane,  and  thus  prevent  the  acids  from  coming  in  direct 
contact  with  it,  while  there  is  not  a  single  condition  in  which 
a  soluble  bismuth  salt  is  indicated.  Another  important  point 
is,  that  the  subnitrate  and  subcarbonate,  being  insoluble,  can 
be  given  in  very  large  doses  (some  physicians  give  as  much 
as  two  to  four  drams  at  a  dose)  without  any  danger  of 
producing  toxic  effects.  Even  the  supposed  advantage  of  the 
salt  in  question — its  solubility — is  a  very  uncertain  quantity ; 
i,  e.,  it  loses  the  ammonia  rapidly,  and  the  solubility  becomes 


PRESCRIPTION  INCOMPATIBILITIES  57 

impaired.  Bismuth  and  ammonium  citrate  is  soluble  only 
in  an  alkaline  or  in  a  perfectly  neutral  solution.  In  this 
prescription  the  hydrochloric  acid  decomposes  it,  forming 
ammonium  chloride  and  bismuth  citrate  precipitating.  Grad- 
ually the  bismuth  citrate  will  also  be  changed  by  the  HC1 
into  bismuth  chloride  and  oxychloride. 

The  reactions  may  be  expressed  as  follows: 

I.    BiCeHaO:  (NIL)  aC.ILOT  +  3HC1  =  BiC.HsOr  +  3NH«C1  + 

H.C.H.Oi 

II.    BiCaH.Or  +  3HC1  =  Bid.  +  H.CJLOr 
III. 


The  above  prescription  may  be  dispensed,  but  it  is  just 
as  well  to  take  the  citrate  of  bismuth  from  the  start  as  to 
take  the  double  salt  and  have  the  citrate  precipitated  out. 

81.  Solut.  Fowleri  ...............................  10.0 

Tr.  Ferri  Chloridi  ...........................  20.0 

Glycerini   ...................................  30.0 

Aquae   ......................................  60.0 

S.:     Cochlear  parvurn  post  prandiura. 

One  would  think  that  the  potassium  carbonate  in  the  Fow- 
ler's solution  would  precipitate  the  iron.  This  is  not  the 
case,  however,  because  the  free  HC1  in  the  tincture  neutralizes 
the  potassium  carbonate;  carbon  dioxide  is  given  off,  which 
is  seen  by  the  active  effervescence  which  takes  place  when 
the  tincture  and  the  liquor  are  mixed.  The  directions  are  : 
A  teaspoonful  —  literally  a  small  spoon  —  after  dinner.  (I 
would  advise  the  readers,  especially  the  young  drug  clerks, 
to  pay  attention  to  the  directions  in  the  presented  prescrip- 
tions; they  may  thus  learn  many  common  Latin  expressions.) 

82.  Spir.  Ammon.  Arom  ........................  3  J 

Tr.  Ferri  Chlor  ...................  <.  .........  3  ij 

Quinin.  Sulph  ..............................  3  ss 

Tr.  Digritalis  ...............................  3  ij 

Glycerini    ..................................  3  iss 

Aquae   ..............................  .  .  .  .ad  3  viij 


58  PRESCRIPTION  INCOMPATIBILITIES 

There  are  three  kinds  of  incompatibility  in  this  prescrip- 
tion, which  the  doctor  insisted  on  having  dispensed  just  as 
written.  The  tincture  of  iron  does  not  contain  enough  hydro- 
chloric acid  to  neutralize  all  the  ammonia  water  and  ammo- 
nium carbonate  present  in  the  aromatic  spirit.  There  will 
consequently  be  a  precipitate  of  ferric  hydroxide.  The  sec- 
ond thing  the  spirit  will  do,  is  to  precipitate  the  quinine, 
which  would  otherwise  have  been  readily  dissolved  by  the 
tincture  of  iron  (due  to  its  containing  free  HC1)  ;  the  third 
point  is  the  tannin  of  the  digitalis  will  yield  a  greenish-black 
color  with  the  iron.  As  to  dispensing  the  prescription,  I  will 
repeat :  As  long  as  there  is  no  dangerous  poison  in  the  mix- 
ture and  the  doctor  wants  to  have  it  that  way,  let  him  have 
it.  A  fourth  point  of  incompatibility  might  be  mentioned: 
The  separation  of  the  oils  from  the  aromatic  spirit  by  the 
water;  but  this  is  of  little  importance  in  comparison  with 
the  other  difficulties. 

83.    Ferri  Pyrophosphatis  3  ij 

Acidi  Phosphoric!  Dil 3  iij 

Syr.  Rub.  Idaei 5  j 

Aquae  3  iv 

Practically  everything  said  in  regard  to  soluble  ferric 
phosphate  (see  prescription  111)  is  applicable  to  ferric 
pyrophosphate,  as  the  latter  is,  like  the  phosphate,  made  solu- 
ble by  the  aid  of  sodium  citrate.  The  phosphoric  acid  will 
decompose  the  soluble  ferric  pyrophosphate  and  cause  a  pre- 
cipitate. 

,84.    Potassii  Chloratis 3  j 

Acjdi  Tannici  3  ss 

"S.:  3  j  in  cup  of  hot  water,  for  a  gargle. 
I  felt  almost  like  apologizing  for  putting  down  this  pre- 
scription, it  is  so  old  and  so  well  known.  But  I  suddenly  rec- 
ollected the  accident  in  Greenwich  street,  where  a  drug  clerk 
blew  up  half  the  store  and  nearly  lost  his  life  from  the 
.injudicious  handling  of  potassium  chlprate  and  sodium  sali- 


PRESCRIPTION  INCOMPATIBILITIES  69 

cylate,  and  then  I  saw  that  no  apology  was  necessary.  It  is 
just  those  easy,  well-known  things  that  need  be  constantly 
kept  in  mind,  constantly  referred  to.  Potassium  chlorate  is 
a  great  oxidizing  agent.  An  oxidizing  agent  is  a  substance 
which  readily  gives  up  its  oxygen  to  other  compounds.  To 
the  oxidizing  agents  belong  the  chlorates,  nitrates,  perman- 
ganates, chromates,  etc.  Oxidizable  substances  are  such  as 
readily  combine  with  oxygen.  To  the  easily  oxidizable  sub' 
stances  belong  sulphur,  phosphorus  and  most  organic  sub- 
stances. If  the  potassium  chlorate  were  rubbed  rather  vig- 
orously with  the  tannic  acid  in  a  mortar,  an  explosion  would 
almost  surely  result.  The  right  way  is  to  powder  the  potas- 
sium chlorate  separately  (and  even  this  must  be  done  gently, 
because  even  if  rubbed  violently  by  itself  an  explosion  is 
apt  to  result)  and  mix  lightly  with  the  tannic  acid  on  a  sheet 
of  paper  by  the  aid  of  a  horn  spatula.  Instruct  the  patient 
to  be  careful. 

85.  Potass.  Permangan 3  ss 

Acidi  Tannici   5  ij 

Alum,  et  Potass.  Sulph 5  iv 

Acidi  Borici 3  xiJ 

M.  et  ft.  pulvis  secundum  art  em. 

S. :     5  ss  m  4  qts.  of  hot  water,  as  a  douche  every  morn- 
ing and  night. 

The  remarks  on  the  previous  prescription  apply  also  to 
this.  The  permanganate  should  be  first  powdered  carefully 
(it  need  not  be  in  a  fine  powder)  by  itself,  then  mixed  with 
the  boric  acid,  alum  and  lastly  with  the  tannic  acid.  It 
may  be  remarked  that  the  physician  might  as  well  have  left 
out  the  permanganate,  because  when  the  solution  is  made  it 
is  reduced  to  a  manganate  by  the  tannic  acid. 

86.  Acidi  Picrici 3  j 

Cocainae  Mur 3  ss 

Aquae   0  j 

S. :     Apply  on  lint  every  hour. 


60  PRESCRIPTION  INCOMPATIBILITIES 

This  is  a  somewhat  modern  prescription.  It  was  written 
by  a  well-known  physician,  who  used  to  be  assistant  to  the 
Chair  of  Materia  Medica  in  one  of  our  colleges.  Picric  acid 
has  been  recommended  as  an  excellent  remedy  for  burns. 
Wishing  to  obviate  any  possible  burning  sensation  from  the 
picric  acid,  the  physician  orders  some  cocaine  with  it;  but 
in  doing  this  he  loses  sight  of  the  fact  that  picric  acid  is  an 
excellent  precipitant  of  almost  all  alkaloids.  When  a  solu- 
tion of  picric  acid  is  added  to  a  solution  of  cocaine  hydro- 
chloride,  the  mixture  becomes  at  once  turbid,  and  soon  the 
crystals  begin  to  separate  out.  There  can  be  no  two  opinions 
as  to  what  course  is  to  be  pursued  in  the  present  case ;  the 
cocaine  is  to  be  left  out.  Not  only  is  it  useless,  because  pre- 
cipitated in  an  insoluble  condition,  but  if  applied  in  that 
insoluble  form  it  would  do  mischief  by  irritating  the  tender, 
recently  burned  surface.  Of  course,  the  physician  is  to  be 
informed  of  the  facts  in  the  case. 

87.  Sodii  Salicyl 15.0 

Acidi  Citrici  5.0 

Syr.  Rub.  Idaei  30.0 

Aquae  150.0 

Ft.  solutio.     S.:  I  ss  t.i.d.  p.c. 

This  is  another  one  of  those  prescriptions  which  vividly 
recall  to  my  memory  the  good  old  junior  days  some  thirty 
years  ago.  One  busy  afternoon  we  received  the  above  pre- 
scription. The  proprietor  sent  in  a  very  polite  note  to  the 
physician,  telling  him  that  he  was  no  doubt  aware  of  the 
fact,  but  it  probably  had  slipped  his  mind,  that  citric  acid 
would  decompose  the  sodium  salicylate,  with  the  consequent 
precipitation  of  the  salicylic  acid ;  whether  he  would  not  or- 
der to  leave  out  the  citric  acid,  or  give  an  equivalent  amount 
of  potassium  citrate  additionally.  The  physician  made  no 
reply,  but  appeared  personally  after  a  short  while.  "You 
must  be  very  peculiar  in  making  up  prescriptions;  I  made 
up  that  same  prescription  a  dozen  times  at  X's  drug  store, 


PRESCRIPTION  INCOMPATIBILITIES  61 

and  they  never  made  any  remarks;  I  always  saw  that  the 
patients  had  a  perfectly  clear  solution."  Being  of  course 
absolutely  certain  of  our  being  in  the  right,  we  told  him  that 
if  X  obtained  a  clear  solution  there  was  no  sodium  salicylate 
in  his  mixture,  and  we  advised  him  to  take  the  prescription 
to  X  's  drug  store,  go  behind  the  counter  and  watch  the  clerk 
prepare  it.  He  did.  The  clerk  mixed  all  the  ingredients  as 
prescribed,  and  then  filtered  the  mixture.  That  physician 
has  since  then  had  a  good  deal  more  respect  for  us  than  he 
did  for  X.  The  reaction  is  simple : 

SNaCrlLO.  +  H.C.H.O,  =  Na»C.HsC>T  +  3HCiH.Ot. 

88.  Potassii  Permang 1.5 

Morph.  Sulph 0.25 

Ext.  Liquir q.s.  ut  fiat  massa 

in  pilulas  No.  xxiv  dividenda. 

As  explained  in  a  previous  prescription  (No.  52),  potas- 
sium permanganate  must  not  be  brought  in  contact  with  or- 
ganic matter,  as  it  becomes 'decomposed.  In  the  present  in- 
stance there  will  be  a  double  reaction  which  will  make  the 
pills  entirely  worthless.  The  potassium  permanganate  be- 
comes reduced  by  the  morphine  and  liquorice  to  potassium 
manganate  and  manganese  dioxide;  the  morphine  becomes 
oxidized,  and  has  no  longer  the  properties  of  morphine.  The 
physician  should  be  apprised  of  the  facts  in  the  case. 

89.  Morphin.  Sulph grn.  ij 

Spt.  Aether.  Nitrosi 3  ss 

Fl.  Ext.  Bellad min.  xij 

Aquae    ad  3  ij 

S. :    3  j  pro  re  nata. 

Morphine  with  sweet  spirit  of  niter  produces  a  yellow 
solution,  due  to  the  oxidation  of  the  morphine  by  the  nitrous 
compounds  present  in  the  spirit.  The  prescription  may  be 
dispensed,  but  I  would  not  be  astonished  if  I  got  little  of  the 
anodyne  effects  of  the  morphine,  and  I  think  the  physician 


62  PRESCRIPTION  INCOMPATIBILITIES 

would  be  thankful  if  his  attention  were  called  to  the  incom- 
patibility. 

90.  Morph.  Sulph gr.  ij 

Liquor.  Potassii  Hydrox 3  ij 

Aquae  Chloroform! 

Fluidext.  Tritici 

Glycerini    aa  3  3 

"This  prescription  is  incompatible,  because  the  liquor  po- 
tassii  hydroxidi,  being  an  alkali,  will  precipitate  the  mor- 
phine." Give  this  prescription  at  an  examination,  and  al- 
most every  one  of  those  answering  it  at  all  would  answer  it 
in  words  indicated  above.  But  this  prescription  is  not  in- 
compatible. True,  morphine  salts  are  precipitated  by  po- 
tassium and  sodium  hydroxides,  but  the  precipitates  are  re- 
dissolved  by  an  excess  of  the  alkali.  In  this  case  there  is 
more  than  sufficient  solution  of  potass,  hydroxide  to  redis- 
solve  the  precipitated  morphine  and  to  keep  it  in  solution. 
If,  instead  of  2  dr.,  there  were  prescribed  only  a  few  drops 
of  liquor  potassae,  the  prescription  would  be  incompatible 
and  could  not  safely  be  dispensed. 

91.  Strych.  Sulph gr.  j 

Liquor  Potassii  Hydro*: 3  ij 

Aquae  Chloroformi 

Ext.  Tritici  Fl. 

Glycerini    aa  5  j 

This  prescription  is  by  the  same  physician  who  wrote  the 
previous  one.  That  one  was  for  the  acute  irritable  stage  of 
cystitis;  after  that  stage  had  passed,  he  prescribed  a  tonic 
instead  of  a  sedative.  While  the  first  prescription  was  dis- 
pensed without  hesitation,  it  was  deemed  obligatory  to  notify 
the  physician  that  it  would  not  be  quite  safe  to  dispense  this 
second  one ;  and  he  was  very  thankful  for  the  information,  as 
the  really  good  physicians  always  are,  and  ordered  the  strych- 
nine in  tablet  form.  The  reason  of  the  incompatibility  is  that 


PRESCRIPTION  INCOMPATIBILITIES  63 

strychnine  (alkaloidal)  is  precipitated  and  is  not  redissolved 
by  excess  of  alkali. 

92.  Liq.  Plumbi  Subacetatis 3  ij 

Solut.  Ac.  Borici  Satur 5  VJ 

S. :     Apply   externally. 

A  milky  white  precipitate  results  when  the  two  solutions 
are  mixed,  due  to  the  formation  of  lead  borate.  This  chem- 
ical is  formed  only  in  an  alkaline  medium.  Its  formation 
can  therefore  be  prevented  in  two  ways :  either  by  adding  a 
few  drops  of  acetic  acid  to  the  liquor  plumbi  subacetatis,  to 
neutralize  its  alkalinity;  or  by  taking  an  equivalent  quan- 
tity of  lead  acetate  (in  this  case,  about  half  a  dram).  Either 
expedient  is  permissible;  a  perfectly  clear  solution  will  re- 
sult in  each  case. 

LEAD  SALTS  ARE  INCOMPATIBLE  WITH  BORIC  ACID  IN  AN 
ALKALINE  MEDIUM. 

93.  Plumbi  Acetatis 0.3 

Sodii  Biboratis 0.5 

Aquae  Rosae  40.0 

S.:     Drop  3  drops  into  each  eye  every  4  hours. 

The  same  reaction  will  take  place  here  as  in  the  previous 
prescription,  but  the  alkalinity  is  here  due  not  to  the  lead 
salt  but  to  the  borax.  The  mixture  should  not  be  dispensed 
in  this  condition,  especially  as  it  is  to  be  used  with  an  eye 
dropper.  The  best  thing  to  do  is  to  use  an  equivalent  quan- 
tity of  boric  acid;  the  solution  will  then  be  perfectly  clear. 
Glycerin  will  also  prevent  precipitation.  (For  a  full  discus- 
sion of  this,  see  the  next  prescription.)  There  is  something 
else  wrong  with  this  prescription,  more  important  even  than 
the  incompatibility ;  namely,  the  employment  of  lead  in  the 
eye.  Salts  of  lead  should  never  be  employed  on  the  eyeball, 
as  several  cases  of  corneal  opacities  have  been  reported  from 
their  use,  due  to  the  deposition  of  lead. 

LEAD  SALTS  ARE  INCOMPATIBLE  WITH  BORAX  IN  SOLUTION  : 
LEAD  BORATE  PRECIPITATES. 


64  PRESCRIPTION  INCOMPATIBILITIES 

94.    Plumbi  Acetatis ^  ss 

Sodii  Boratis 3  j 

Glycerin!   B  ^ 

Aquae q.s.  ad  3  iv 

This  prescription  differs  from  the  preceding  one  in  that 
it  contains  an  additional  ingredient,  glycerin,  which  makes 
"all  the  difference  in  the  world"  in  this  case.  The  combina- 
tion is  a  good  illustration  of  what  actual  aid  chemical  knowl- 
edge is  to  us  in  preventing  and  correcting  incompatibilities. 
If  the  borax  be  mixed  with  the  lead  acetate,  a  precipitate  will 
occur,  as  explained  in  the  previous  two  prescriptions ;  but  the 
precipitate  dissolves  on  the  addition  of  the  glycerin.  If  the 
glycerin  be  added  to  a  solution  of  the  lead  acetate  and  then 
mixed  with  the  borax,  a  precipitate  will  also  form  which  will 
redissolve  on  shaking,  provided  there  be  sufficient  glycerin 
present.  But  if  the  glycerin  be  added  to  the  dissolved  borax 
and  then  mixed  with  the  sugar  of  lead,  no  precipitation  will 
take  place.  What  is  the  cause  of  this? 

To  understand  this  fully,  we  must  examine  into  the  chem- 
istry of  borax.  Borax  is  not  the  normal  borate  of  sodium,  of 
the  formula  Na3B03.  Its  formula  is  Na2B4O7,  and  chemically 
it  is  sodium  penta-meta-tetra-borate,  or  it  is  penta-meta-tetra- 
boric  acid,  in  which  the  two  hydrogens  have  been  replaced 
by  two  atoms  of  sodium.  The  word  "meta"  means  change. 
A  meta  acid  is  an  acid  resulting  by  the  subtraction  of  the 
elements  of  one  or  more  molecules  of  water  from  the  regular 
or  or-tho  acid.  For  instance,  phosphoric  acid  is  HaPO4 ;  sub- 
tract one  H20  and  meta-phosphoric  acid — HP03 — is  left. 
Boric  acid  is  H3B03.  Subtract  one  H2O,  and  meta-borie  acid 
is  obtained.  Now,  penta-meta-tetra-boric  acid  means  boric 
acid,  which  results  by  subtracting  5H2O  from  4  molecules 
of  boric  acid.  4XH3B03=H12B4O12;  and  H12B4012— H1005 
(:=5XH20)—  H2B4O7.  Replace  the  two  hydrogens  by  so- 
dium, and  you  get  the  formula  of  the  official  borax— Na2B4OT. 
When  this  borax  is  mixed  with  glycerin,  it  is  decomposed 
into  sodium  meta-borate  and  boric  acid,  and  is  no  longer 


PRESCRIPTION  INCOMPATIBILITIES  65 

alkaline.     This  rather  remarkable  reaction  can  be  expressed 
by  the  following  two  equations: 

1.    NazB40T  +  C,H.  (  OH  )  ,  =  2NaBO,  +  H.BO,  + 


2. 


Sodium          Glycerin  Sodium         Boric       Glyceryl  borate 

Borate  Metaborate         Acid 


Glyccryl         Water         Glycerin         Boric  acid 
Borate 


As  is  seen,  glyceryl  borate  is  one  of  the  intermediate  prod- 
ucts, but  is  redecomposed  by  the  water  into  glycerin  and 
boric  acid.  As  the  solution  is  now  acid,  lead  borate  is  not 
formed. 

95.  Zinei  Sulph  ..............................  grn.  xvj 

Sodii  Boratis  ............................  grn.  xxx 

Glycerin!   ..................................  5  ss 

Aquae    ......................  ............  ad  %  iv 

S.  :     Use  as  an  injection. 

ZINC  SULPHATE  AND  BORAX  YIELD  A  PRECIPITATE  OF  ZINO 
BORATE. 

But  in  the  presence  of  glycerin,  boric  acid  is  formed,  and 
no  precipitate  results.  (See  the  remarks  on  prescription  No. 
93  and  prescription  No.  94.) 

96.  Aconitinae  Cryst   ............................  0.06 

Atropinae  Sulph  ...........  .  ..................  0.12 

01.  Olivae  ..................................  8.00 

S.:     Apply  to  neuralgic  spots. 

The  alkaloidal  salts  are  not  as  a  rule  soluble  in  the  fixed 
oils,  while  the  uncombined  alkaloids  are.  Atropine  should 
be  used  instead  of  its  sulphate. 

97.  Acidi  Salicylici  ..............................  3  ij 

Aquae  Destill  ...............................  3  *v 

Fiat  Solutio.    S.:    Apply  externally. 

That  many  physicians  do  not  know  the  solubilities  of  chem- 
icals is  a  well-known  fact.  It  is  perhaps  pardonable.  Never- 
theless, some  prescriptions  are  simply  exasperating  to  the 


66  PRESCRIPTION  INCOMPATIBILITIES 

druggist.  Here  the  physician  expects  the  pharmacist  to  ac- 
complish the  impossible ;  to  dissolve  a  substance  in  4  fl.  ozs. 
of  water,  when  it  would  require  fully  seven  and  a  half  pints, 
or  120  fl.  ozs.,  to  effect  solution !  Salicylic  acid  is  soluble  in 
460  parts  of  water ;  that  is,  about  1  grn.  in  1  oz.  As  there  are 
120  grn.,  it  would  require  120  fl.  ozs.  Boiling  the  water  would 
only  make  matters  worse,  because  while  the  salicylic  acid 
would  be  dissolved  temporarily,  it  would  separate  out  in 
large  needle-shaped  crystals  as  the  solution  became  cold. 
The  physician  should  be  informed  of  the  trouble. 

98.  Ac.  Boric!  3  ij 

Aquae  Destill 3  iy 

Fiat  Collyrium.  S. :  Use  with  eye-dropper. 
Only  about  70  grn.  would  dissolve  in  4  fl.  ozs.  of  water, 
and  this  is  all  that  should  be  used ;  i.  e.,  a  saturated  solution 
should  be  dispensed.  The  physician  need  not  be  consulted. 
The  addition  of  glycerin  to  increase  the  solubility  of  the 
boric  acid  is  not  advisable,  in  view  of  the  fact  that  the  solu- 
tion is  to  be  used  for  the  eyes.  Glycerin,  even  when  diluted, 
sometimes  proves  irritating. 

99.  Menthol!    grn.  x 

Thymol!    grn.  iij 

Eucalyptoli    min.  v 

Cocainae  Hydrochlo'r grn.  x 

Petrolati  Liquid! |  ij 

S. :     Use  with  spray  night  and  morning. 

This  is  a  very  common  prescription.  The  first  three  in- 
gredients dissolve  without  any  difficulty  in  the  liquid  petro- 
latum, but  the  cocaine  hydrochloride  is  absolutely  insoluble 
therein.  Cocaine  alkaloid  is  soluble,  and  that  should  be  used. 

100.  Morphin.  Sulph grn.  xij 

Ac.  Oleici 3  ss 

For  external  use  only. 

The  alkaloidal  salts  are  not  soluble  in  oleic  acid ;  the  free 
alkaloids  are.  Morphine  should  be  used  instead  of  morphine 


PRESCRIPTION  INCOMPATIBILITIES  67 

sulphate.  If  morphine  is  not  at  hand— and  it  seldom  is  in 
the  average  drug  store — it  can  easily  be  prepared  as  follows : 
Make  an  aqueous  solution  of  morphine  sulphate,  add  ammo- 
nia water  until  the  precipitate  ceases  to  form,  collect  the  pre- 
cipitate (which  is  free  morphine)  and  dry  it  between  filter 
paper.  Dissolve  the  alkaloid  in  the  oleic  acid,  using  very 
gentle  heat  if  necessary. 

101.  Strontii  Bromidi  15.0 

Divide  into  powd.  No.  xxx. 

There  are  10  chances  to  1  that  if  the  above  prescription  is 
dispensed  as  directed,  that  is,  in  powder  form,  the  patient 
will  have  no  powders  to  take ;  he  will  only  find  wet  pieces  of 
paper.  Wax  paper  or  parchment  paper  will  not  prevent  the 
deliquescence  altogether.  Strontium  bromide  is  one  of  the 
most  deliquescent  salts  we  have,  and  the  druggist  should  re- 
fuse to  dispense  it  in  powder  form.  The  physician  should 
be  informed;  he  will  probably  order  the  prescribed  quan- 
tity to  be  dissolved  in  120  c.  c.  of  water ;  the  solution  to  b«» 
taken  in  teaspoonful  doses.  (Some  varieties  of  strontium 
bromide  are  but  slightly  deliquescent.) 

102.  Strontii  Bromidi 5  i,j 

Strontii  lodidi   5  j 

Morphin.  Sulph grn.  iij 

Aquae    ad  5  ij 

This  prescription  presents  a  double  incompatibility.  Not 
only  is  the  morphine  liable  to  be  precipitated  by  the  bromide 
and  iodide  of  strontium  (as  it  is  by  any  iodide  or  bromide) 
but  the  sulphate  radicle  in  the  morphine  will  precipitate  a 
part  of  the  strontium  as  a  sulphate. 

103.  Strontii  Bromidi  5  ij 

Potassii  Acetatis  3  j 

Lithii  Citratis 3  ij 

Tr.  Digitalis  3  ij 

Aquae    ad  3  ij 

This  prescription  was  recently  received  from  a  druggist, 


68  PRESCRIPTION  INCOMPATIBILITIES 

who  wrote  that  he  made  up  the  mixture  in  different  ways, 
but  each  time  got  an  abundant  precipitate.  He  was  aston- 
ished that  a  chemical  reaction  should  take  place  in  such  an 
apparently  simple  prescription,  and  wanted  to  know  what 
the  reaction  was.  The  reaction  is  a  simple  one.  The  lithium 
citrate  decomposes  the  strontium  bromide,  with  the  forma- 
tion of  strontium  citrate  (which,  being  insoluble,  precipi- 
tates) and  lithium  bromide. 

3SrBr,  +  2LisC6H50I  =  Sr,(C8ILO,)a  +  GLiBr. 

STRONTIUM  SALTS  SHOULD  NOT  BE  PRESCRIBED  WITH  CI- 
TRATES IN  SOLUTION. 

104.  Strontii  Bromidi  3  ij 

Natrii  Bicarbon  3  iss 

Aquae 3  iy 

The  strontium  bromide  is  decomposed  and  precipitates  as 
a  carbonate;  but  in  addition  to  this,  there  is  quite  an  active 
evolution  of  carbon  dioxide,  so  that  if  put  at  once  in  a  bottle 
the  cork  may  be  blown  out.  The  reaction  is  as  follows : 

SrBr2  +  2NaHCO,  =  SrCOs  +  2NaBr  +  H=0  +  CO,. 

SOLUBLE  STRONTIUM  SALTS  SHOULD  NOT  BE  PRESCRIBED  IN 
SOLUTION  WITH  SOLUBLE  CARBONATES  OR  BICARBONATES. 

105.  Aluminis    grn.  xl 

Plumbi  Acetatis  grn.  xx 

Aquae  Destill 5  *v 

S.:  Inject  two  syringefuls  3  times  a  day. 
The  official  alum  is  a  double  sulphate  of  aluminum  and 
potassium  or  aluminum  and  ammonium,  and  with  lead  acetate 
forms  lead  sulphate,  which  precipitates.  In  this  case,  the 
prescription  being  intended  as  a  gonorrheal  injection,  the 
precipitate  should  not  be  filtered  out  unless  the  physician  so 
orders.  The  reaction  which  takes  place  is  as  follows: 

KA1  (SO.)  a+2Pb  ( C.H,Oi)  *=A1  ( C.H.O.)  ,+KC2H,OH-2PbS04 

Alum  Lead  Acetate    Alum.  Acetate     Potass.         Lead 

Acetate       Sulph. 


PRESCRIPTION  INCOMPATIBILITIES  69 

It  may  not  be  out  of  place  to  note  here  that  this  solution 
of  aluminum  acetate  is  practically  the  well  known  "Solutio 
Burowii"  which  at  one  time  was  very  popular  on  the  con- 
tinent, but  later  came  into  disuse ;  lately  aluminum  acetate 
is  again  coming  into  extensive  use. 

106.  Aluminis    grn.  v 

Plumbi  Acetatis grn.  iij 

Aquae  Dest 3  vj 

S. :     Three  drops  into  each  eye. 

In  this  case,  the  precipitate  should  be  carefully  filtered  out, 
as  the  insoluble  lead  sulphate  would  cause  great  irritation 
to  the  eye. 

107.  Aluminis   3  xiv 

Plumbi  Acetatis   3  VJ 

M.  ft.  pulvis.    Detur  ad  scatulam. 

S. :     Tablespoonful  in  a  quart  of  water,  as  a  douche. 

When  alum  and  lead  acetate  are  rubbed  together  in  a 
mortar  a  soft  mass  is  obtained,  due  to  chemical  reaction  and 
the  consequent  liberation  of  the  very  large  amount  of  water 
of  crystallization.  This  can  be  prevented  by  using  the  pro- 
portionate amount  of  the  dried  salts,  or  by  mixing  the  salts 
lightly,  without  trituration.  But  this  is  not  the  point  I 
wish  to  bring  out.  My  contention  is  that  the  prescription  is 
a  bad  one  to  dispense.  The  reason  may  appear  a  trivial  one 
but  it  is  to  be  counted  with  nevertheless.  The  insoluble  lead 
sulphate  clogs  up  the  little  holes  of  the  vaginal  tube  and 
makes  the  douching  very  inconvenient.  The  doctor  should 
be  consulted ;  perhaps  he  would  agree  to  use  zinc  acetate 
instead.  Several  instances  have  come  to  my  notice,  where 
ladies  refused  to  use  or  complained  about  the  above  powder. 

The  above  three  prescriptions  well  illustrate  how  different 
directions  at  the  end  of  the  same  prescription  may  differently 
determine  the  conduct  of  the  pharmacist  in  dispensing  that 
prescription. 


70  PRESCRIPTION  INCOMPATIBILITIES 

108.  Zinci  Sulphatis  grn.  iij 

Sodii  Boratis   grn.  x 

Aquae  Rosae  3  j 

M.  ft.  Collyrium. 

A  precipitate  of  zinc  borate  (and  some  zinc  hydrate)  re- 
sults. The  remarks  concerning  prescription  No.  93  apply  to 
this  one  as  well.  (See  also  prescription  95.) 

109.  locli  Resublim 3  j 

Adipis  Lanae 3  j 

To  put  the  iodine  in  a  mortar,  make  an  attempt  at  powder- 
ing it,  and  then  rub  it  up  with  the  woolfat,  as  I  saw  a  drug- 
gist do  it,  shows  the  acme  of  incompetence.  "When  solids  are 
to  be  incorporated  with  an  ointment  base,  they  should  be 
either  in  the  form  of  a  fine,  impalpable  powder,  or  a  soft, 
smooth,  homogeneous  mass;  or,  when  possible,  in  solution. 
It  is  next  to  impossible  to  reduce  iodine  to  an  impalpable 
powder.  A  little  potassium  iodide  and  water  should  be  added, 
so  as  to  dissolve  the  iodine  (in  this  case  about  15  grains  Of 
potassium  iodide  and  y2  to  1  dram  of  water)  ;  then  only  is 
it  to  be  gradually  incorporated  with  the  woolfat. 

110.  Potassii  lodidi    8.0 

Adipis  60.0 

M.  ft.  ung. 

Here  again,  if  the  pharmacist  is  up  to  the  mark,  he  will 
first  dissolve  the  potassium  iodide  in  hot  water  (about  iy2 
drams),  and  he  will  add  a  little  sodium  thiosulphate,  to  pre- 
vent the  liberation  of  iodine  and  the  consequent  discolora- 
tion of  the  ointment.  He  will  thus  avoid  the  possible  bring- 
ing back  of  the  salve  in  a  few  days  with  the  tale  that  "it 
has  turned  brown  and  mamma  is  afraid  to  use  it;  wouldn't 
you  please  make  up  another  jar?" 

111.  Ferri  Phosphatis  3  iss 

Acidi  Phosphor.  Dil 3  ij 

Syr.  Simpl 3  ss 

Aquae ad  |  iij 


PRESCRIPTION  INCOMPATIBILITIES  71 

This  prescription  has  become  a  standing  nuisance  to  every 
one  who  has  to  do  with  prescription  incompatibilities.  It  is 
one  of  the  most  frequent  prescriptions  in  my  collection,  and 
it  can  be  found  in  almost  any  volume  of  every  pharmaceutical 
journal.  The  reason  of  it  lies  perhaps  in  the  confusion  which 
exists  in  the  average  druggist's  and  physician's  minds  as 
to  the  difference  between  the  true  chemical  and  the  official 
ferric  phosphate.  The  former — Fe3(P04)2 — is  a  whitish  pow- 
der, very  slightly  soluble  in  water  but  soluble  in  solutions 
of  the  alkaline  citrates  and  in  strongly  acid  solutions.  The 
official  phosphate  is  a  combination  of  ferric  phosphate  and 
sodium  citrate,  and  bears  the  title  (in  its  synonym)  "soluble 
ferric  phosphate"  to  distinguish  it  from  the  true  chemical, 
insoluble  phosphate.  On  adding  phosphoric  acid,  the  sodium 
citrate,  which  acts  as  a  solvent  for  the  iron  salt,  is  decom- 
posed, a  little  sodium  phosphate  and  citric  acid  being  formed. 
As  those  do  not  act  any  more  as  a  solvent  for  the  ferric 
phosphate,  the  latter  precipitates.  To  leave  out  the  phos- 
phoric acid  would  be  inadmissible,  as  it  is  an  important 
medicinal  ingredient.  If  diluted  meta-phosphoric  acid 
(HP03,  also  called  "glacial"  phosphoric  acid)  be  used,  no 
precipitation  will  occur.  For  my  part,  I  see  no  objection  to 
dispensing  the  above  mixture  as  written,  with  a  shake  label. 

112.     Ferri  Phosphatis  Solubilis 3  iss 

Acidi  Phosphorici  3  ij 

Syr.  Simpl 5  ss 

Aquae  Foeniculi ad  3  iij 

In  this  prescription  the  physician  ordered  phosphoric  acid, 
concentrated,  and  not  the  diluted.  No  precipitation  will 
take  place,  because  as  stated  above  ferric  phosphate  is  soluble 
in  strongly  acid  solutions.  It  may  also  be  noticed  here,  that 
if  the  amount  of  the  acid  be  very  small  in  proportion  to  the 
amount  of  ferric  phosphate  used,  no  precipitate  will  form, 
as  the  acid  is  either  too  dilute  to  decompose  the  sodium  citrate 
at  all,  or  only  a  very  insignificant  proportion  of  the  latter  is 


72  PRESCRIPTION  INCOMPATIBILITIES 

decomposed,  the  balance  still  being  sufficient  to  act  as  a 
solvent.  In  the  pharmaceutical  journals  where  the  above 
prescriptions  are  criticized,  the  statement  is  generally  made 
that  soluble  ferric  phosphate  and  ortho-phosphoric  acid  are 
incompatible;  but  I  never  found  any  reference  to  the  fact 
that  the  proportion  of  phosphoric  acid  used  made  quite  some 
difference.  To  the  question:  Why  is  a  solution  of  soluble 
ferric  phosphate  of  a  nice  green  color,  while  a  solution  of 
ferric  phosphate,  to  which  a  sufficient  quantity  of  acid  has 
been  added  to  redissolve  the  formed  precipitate,  is  perfectly 
colorless  ?  The  following  explanation  may  be  satisfactory : 
The  soluble  ferric  phosphate  is  not  a  simple  mixture,  but 
more  or  less  of  a  chemical  combination  of  two  salts.  It  is 
a  kind  of  double-salt  and  the  best  name  for  it,  in  my  opinion, 
would  be  "ferri-sodio-phospho-citrate."  It  is  this  double- 
salt  that  is  of  a  green  color.  On  adding  phosphoric  acid  it 
is  decomposed,  ferric  phosphate  (true),  sodium  phosphate, 
and  citric  acid  being  formed.  None  of  these  compounds 
possesses  a  green  color. 

113.  Ext.  Hyoscyami 3  j 

Ac.  Tannici  3  ss 

Adipis    I  j 

The  extract  is  to  be  rubbed  up  with  a  little  diluted  alcohol 
and  incorporated  with  about  half  an  ounce  of  the  lard;  the 
tannic  acid  is  incorporated  with  the  other  half,  and  the  two 
salves  mixed.  The  tannic  acid  should  not  be  brought  in  im- 
mediate contact  and  rubbed  with  the  extract,  as  the  alkaloids 
of  the  hyoscyamus — hyoscine  and  hyoscyamine — are  thus 
more  likely  to  become  insoluble  tannates. 

114.  Acidi  Carbol min.  v 

Glycer.  Boroglycerini   3  j 

Aquae   3  ij 

S. :     Apply  to  the  throat  with  a  cotton  swab. 
Glycerite  of  boroglycerin  contains  a  very  large  amount  of 
J^oric  acid  in  solution— 31  per  cent,  by  weight.    It  contains 


PRESCRIPTION  INCOMPATIBILITIES  73 

it  in  the  form  of  a  true  chemical  compound,  glyceryl  borate  or 
boroglycerin,  C3H5BO3.  This  will  furnish  an  answer  to  the 
question,  so  often  asked,  why  the  Pharmacopoeia  did  not  name 
this  particular  glycerite  "Glyceritum  Ac.  Borici,"  the  same 
as  "Glycer.  Ac.  Carbolici,"  or  "Glycer.  Ac.  Tannici."  In 
the  last  two  the  acids  are  simply  dissolved  in  the  glycerin, 
while  in  boroglycerin  the  boric  acid  is  chemically  combined 
with  a  portion  of  the  glycerin ;  and  the  glycerite  is  a  solution 
of  this  chemical  compound  in  glycerin.  Now,  boroglycerin 
is  decomposed  in  the  presence  of  water,  as  shown  by  the  fol- 
lowing equation  (see  also  No.  94) : 

C.H.BO,  +  SILO  =  C*H8(OH),  +  H.BO. 
Boro-  Water      Glycerin  Boric  Acid 

glycerin 

That  is,  glycerin  and  boric  acid  are  reformed. 

As  boric  acid  requires  25  parts  of  water  for  solution,  there 
is  not  enough  of  the  latter  to  keep  all  dissolved,  so  that  part 
of  the  acid  precipitates  out.  The  application  to  the  throat 
would  thus  lose  considerably  in  effectiveness.  If  instead  of 
the  water  we  use  glycerin,  wholly  or  in  part,  no  precipitation 
will  take  place ;  and  thi*  is  the  method  to  be  pursued  in  dis- 
pensing the  prescription.  It  is  well  to  note  that  the  pre- 
cipitation will  take  place  only  if  the  boroglyceride  is  fully 
up  to  the  standard  and  has  been  made  up  with  official  glyc- 
erin; a  weak  preparation  will  show  no  change  when  mixed 
with  water. 

115.     Tr.  Nucis  Vomicae  3  iij 

Strychninae  Sulph 3/4  gr. 

Sol.  Fowleri  3  iij 

Syr.  Ferri  lodidi 3  vi 

Elixir  Calisayae ad  $  iij 

Those  who  think  that  it  is  useless  to  worry  with  prescrip- 
tion incompatibilities  would  change  their  minds  if  they  had 
an  opportunity  to  work  in  a  real  pharmacy,  say  where  100 
to  300  prescriptions  are  made  up  daily.  They  would  then 


74  PRESCRIPTION  INCOMPATIBILITIES 

be  convinced  that  the  subject  of  prescription  incompatibili- 
ties is  more  important — to  the  druggist — than  botany,  physics, 
physiology  or  toxicology.  The  above  prescription,  written 
by  an  eminent  physician,  is  a  bad  one.  The  Fowler's  solu- 
tion precipitates  the  strychnine  both  from  the  nux  vomica 
and  from  the  sulphate;  it  also  precipitates  ferrous  carbonate 
from  the  syrup ;  besides,  the  iron  forms  an  inky  mixture  with 
the  tannin  (cincho-tannic  acid)  of  the  calisaya  and — to  finish 
up — some  ferrous  arsenite  is  likely  to  be  formed.  To  dis- 
pense it  as  written  is  absolutely  inadmissible.  A  slight  ma- 
nipulation would  improve  matters  a  good  deal.  Add  very 
carefully  some  diluted  hydrochloric  acid  just  to  neutralize 
the  alkalinity  of  the  Fowler's  solution,  or  to  make  it  very 
faintly  acid.  This  will  obviate  the  precipitation  of  the 
strychnine  and  of  the  ferrous  carbonate.  But  we  must  be 
careful  not  to  add  too  much  acid  as  otherwise  the  ferrous 
iodide  may  be  decomposed,  with  the  liberation  of  free  iodine. 
Leaving  out  the  Fowler's  solution  altogether  (with  the  physi- 
cian's permission)  will  also  obviate  most  of  the  difficulties. 

116.  Ichthyol  8.0 

Ac.  Hydrochlor.  Dil 12.0 

Aquae  Amygd.  Amar 10.0 

S. :  Guttas  quindecim  ter  in  die,  in  paululo  aquae,  post 
cibos. 

This  prescription  is  absolutely  incompatible.  A  dark  resin- 
ous precipitate  collects  on  the  sides  and  bottom  of  the  bot- 
tle, and  the  entire  mixture  becomes  worthless;  even  the  bot- 
tle has  to  be  thrown  away.  Ichthyol,  without  any  further 
specification,  is  ammonium  sulpho-ichthyolate  or  ichthyol 
sulphonate.  Mineral  acids  decompose  it,  the  acid  radical 
combining  with  the  ammonium  and  the  sulpho-ichthyolic  (or 
ichthyol-sulphonic)  acid  precipitating.  The  physician  should 
be  notified  of  the  facts.  The  direction  reads :  Fifteen  drops 
three  times  a  day  in  a  little  water  after  meals. 


PRESCRIPTION  INCOMPATIBILITIES  75 

117.  Ichthyol  3  iij 

Tr.  Nuc.  Vom 3  ij 

Tr.  Capsici 3  iv 

Tr.  Cannab.  Ind 3  ij 

Tr.  Cinch.  Comp ad  3"  iij 

S.:  Teaspoonful  before  and  after  the  principal  meals. 
Ichthyol  being  insoluble  in  alcohol,  a  precipitate  will  grad- 
ually form ;  but  as  the  ichthyol  is  not  decomposed  and  its  vir- 
tues are  not  impaired,  the  mixture  may  be  dispensed  with 
a  "shake"  label,  and  with  instructions  to  keep  the  bottle 
on  the  side.  If  the  bottle  is  stood  up  and  is  not  shaken  fre- 
quently, the  ichthyol  will  c  )llect  in  a  resinous  mass  at  the 
bottom,  which  it  will  be  impossible  to  detach  and  distribute 
throughout  the  bottle. 

118.  Ichthyol   5  iss 

Hydrargyri  Chlor.  Corros gr.  viij 

Potassi  lodidi   5  ij 

Tr.  Cardam.  Comp $  ss 

Aquae  Menthae  Pip ad  3  vj 

S. :     Teaspoonful  4  times  a  day.    Reduce  to  half -teaspoon  3 
times  a  day  if  the  stomach  gets  upset. 

Ichthyol  being  prescribed  in  such  a  great  variety  of  dis- 
orders, it  is  no  wonder  that  it  is  occasionally  prescribed  in 
combination  with  drugs  with  which  it  is  incompatible. 

Recently  the  above  mixture  was  sent  to  me  by  a  druggist, 
asking  whether  I  could  not  do  anything  to  restore  or  to  im- 
prove it ;  it  being  quite  an  expensive  prescription,  he  did  not 
feel  like  throwing  it  out,  but  of  course  he  could  not  send  it 
out  the  way  it  was.  No,  he  could  not,  indeed !  It  was  a 
very  curious  looking  mixture.  In  a  brownish  transparent 
liquid  there  floated  numerous  pieces  that  looked  like  black 
pitch.  Some  of  the  pieces  were  quite  large,  so  that  they 
could  not  get  out  of  the  bottle.  I  told  him  that  there  was 
no  way  of  "restoring"  the  prescription,  nor  was  there  any 
way  of  making  it  up  properly  from  the  start,  except,  perhaps, 
by  making  an  emulsion.  But  that  if  he  did  not  feel  like 


76  PRESCRIPTION  INCOMPATIBILITIES 

throwing  away  the  mixture,  he  should  break  the  bottle,  filter 
the  mixture,  collect  the  precipitate  on  the  filter,  and  dispense 
it  in  48  capsules  (it  was  just  the  right  consistency  to  be 
divided,  without  any  extraneous  addition),  and  instruct  the 
patient  to  take  for  each  dose  a  teaspoonful  of  the  filtered 
liquid  and  one  capsule ;  that  he  should  first  notify  the  doctor, 
however.  The  physician  gave  his  sanction,  and  the  druggist 
acted  as  here  suggested.  The  precipitate  was  due  to  the 
formation  of  potassic  and  mercuric  ichthyol-sulphonates, 
which  are  much  less  soluble  in  water  than  the  ammonium 
ichthyol-sulphonate.  Mercuric  chloride  by  itself,  in  the  doses 
in  which  it  is  usually  given,  may  be  prescribed  with  ichthyol, 
because,  in  the  first  place,  the  precipitate  is  slow  in  forma- 
tion, and,  secondly,  because  it  is  not  of  a  resinous  character 
(sticking  to  the  walls  of  the  bottle),  but  may  be  easily  dis- 
tributed throughout  the  contents  by  shaking. 

119.  Ammon.  Sulpho-ichthyol 3  ij 

Strychninae  Sulph gr.  j 

Quininae  Sulph gr.  xxx 

Syr.  Rub.  Idaei  3  j 

01.  Caryophyllor gtt.  iv 

Aquae  ad     I  iv 

S.:    3  j  ter  in  die,  p.c. 

This  would  be  a  dangerous  prescription  to  dispense.  Ich- 
thyol is  incompatible  with  almost  all  alkaloids,  because  the 
ichthyol-sulphonic  acid  combines  with  them  and  precipitates 
them  as  difficultly  soluble  ichthyol-sulphonates.  In  this  case 
both  the  strychnine  and  the  quinine  would  be  precipitated 
in  the  form  of  a  sticky  resinous  mass ;  and  it  is  not  hard  to 
imagine  the  patient  getting  the  whole  grain  of  strychnine  at 
one  dose.  The  prescription  should  not  be  dispensed. 

120.  Ichthyol   0.0 

Cocainae  Hydrochl 0.6 

Aquae  Best 200.0 

Inject  3  times  a  day,  after  urinating. 
In  order  to  alleviate  the  burning  sometimes  caused  by  a 


PRESCRIPTION  INCOMPATIBILITIES  77 

3  per  cent,  ichthyol  injection  in  very  acute  gonorrheas,  the 
physician  orders  some  cocaine  with  it.  But,  alas!  the  co- 
caine will  do  here  no  good,  because,  being  an  alkaloid  (see 
above)  it  will  be  precipitated  as  cocaine  sulphoichthyolate. 
The  cocaine  should  be  left  out  and  the  physician  informed  of 
the  facts. 

FROM  THE  PRECEDING  FIVE  PRESCRIPTIONS  IT  Is  SEEN  THAT 
ICHTHYOL  Is  INCOMPATIBLE  WITH  (1)  ACIDS,  (2)  ALCOHOL, 
(3)  MERCURIC  CHLORIDE  AND  POTASSIUM  IODIDE  AND  (4)  AL- 
KALOIDAL  SALTS. 

121.  Sol.  Fowleri  5  ij 

Hydrargyri  Bichloridi  gr.  ii j 

Aquae  3  iij 

S. :    3  i  t.i.d.,  p.c.  in  water. 

This  prescription  is  absolutely  incompatible.  In  the  way 
it  is  written,  it  will  of  course  not  be  dispensed  by  any  one,  not 
even  by  the  merest  junior  tyro.  A  variety  of  reactions  will 
take  place,  depending  upon  the  relative  proportion  of  the 
ingredients  and  upon  the  order  of  mixing  them.  As  is  well 
known,  Fowler's  solution  contains  free  potassium  carbonate 
(potassium  bicarbonate  is  taken;  but,  as  explained  in  pre- 
scription No.  63,  any  bicarbonate  in  solution,  when  heated  to 
boiling,  becomes  converted  into  a  carbonate)  ;  this  converts 
the  bichloride  into  mercuric  carbonate,  mercuric  oxide,  and 
mercuric  oxychloride;  these  mercuric  compounds  undergo 
further  changes,  which  end  in  the  separation  of  a  great  deal 
of  the  mercury  in  the  metallic  state.  But  this  is  not  all.  The 
mercury  displaces  the  potassium  in  the  potassium  arsenite, 
forming  mercuric  arsenite  and  possibly  also  arsenate. 

By  adding  some  hydrochloric  acid  to  the  Fowler's  solution, 
so  as  completely  to  neutralize  the  potassium  carbonate,  most 
of  the  trouble  will  be  obviated;  i.  e.,  there  will  be  no  pre- 
cipitate of  mercuric  carbonate  or  oxide,  etc.;  in  fact,  the 
mixture  will  at  first  be  perfectly  clear  and  transparent,  but 
gradually  there  forms  a  slight  precipitate  (of  mercuric  arse- 


78  PRESCRIPTION  INCOMPATIBILITIES 

nite?).     The  prescription  may  be  dispensed  with  a  "shake 
well"  label. 

122.    Ac.  Salicyl.  (from  Wintergreen) 3  ij 

Morphia  Sulph gr.  iii 

Syr.  Aurantii  Cortex   5  i 

Aquae  q.  s ad      3  "J 

Sig.     3  i  every  three  hours. 

The  above  prescription  which  I  reproduce  verbatim  was 
received  by  me  from  a  druggist  in  Portland,  Oregon.  The 
druggist  writes  as  follows :  "I  received  this  prescription  last 
evening.  I  tried  hot  water,  hot  glycerin,  alcohol,  all  of  which 
readily  dissolved  the  acid,  but  in  each  instance  on  cooling 
or  adding  water  or  syrup  the  acid  separated  and  had  a  con- 
sistency not  unlike  very  sour  milk.  I  have  referred  this  pre- 
scription to  other  druggists  but  have  received  no  informa- 
tion. The  physician  informed  me  that  he  had  this  com- 
pounded at  another  pharmacist's  and  secured  a  clear  mix- 
ture. I  have  consulted  all  of  the  authorities  at  hand  but 
none  seem  to  cover  the  case.  I  am  of  the  opinion  that  it  may 
be  myself  and  not  the  1^  that  is  at  fault.  Kindly  inform 
me." 

There  is  no  way  of  dispensing  this  prescription  as  a  clear 
solution.  There  is  no  way  of  dissolving  2  drams  of  salicylic 
acid  in  3  ozs.  of  an  aqueous  menstruum.  It  is  possible  that 
the  doctor  did  get  a  clear  mixture,  but  you  know  what  that 
means  ?  It  means  simply  this :  The  druggist  put  no  salicylic 
acid  in  the  mixture,  or  did  put  in  some,  shook  the  bottle  and 
filtered  out  the  excess  of  acid,  which  in  this  case  means  prac- 
tically the  entire  amount. 

It  is  sad  but  true  that  some  druggists  will  take  liberties 
with  a  doctor's  prescription,  will  change  or  omit  ingredients 
without  notifying  the  doctor,  thus  subjecting  a  fellow  drug- 
gist, who  may  try  to  put  up  the  prescription  honestly,  to 
innumerable  annoyances  and  to  suspicions  of  incompetence 
and  dishonesty. 


PRESCRIPTION  INCOMPATIBILITIES  79 

123.  Liq.  Plumbi  Subacet 2.5 

Mucil.  Acaciae  20.0 

Aq.  Menthae  Pip ad  240.0 

S.:     Use  for  gargle. 

This  prescription  is  a  favorite  one  with  a  prominent  laryn- 
gologist  of  this  city.  A  druggist  who  received  it  not  long 
ago  was  unable  to  dispense  it  on  account  of  incompatibility. 
He  tried  to  make  it  up,  but  obtained  a  mess,  which  he  could 
not  distribute  through  the  bottle.  And  so  he  telephoned  to 
help  him  out  of  the  difficulty.  This  prescription  well  illus- 
trates the  fact,  that  incompatibility  often  depends  upon  the 
relative  quantities  of  the  ingredients  and  upon  the  order  of 
mixing.  Goulard's  extract  is  incompatible  with  mucilage  of 
acacia  (see  I£  67),  but  the  above  may  be  made  up  as  an  homo- 
geneous, permanent  mixture.  Add  the  liquor  plumbi  to  half 
of  the  water,  the  mucilage  of  acacia  to  the  other  half,  and 
mix  the  two  solutions.  (The  druggist  had  added  the  liquor 
plumbi  directly  to  the  mucilage.)  The  mixture  has  the 
appearance  of  diluted  milk. 


124.     Tr.  Ferri  Chlor.  -j 

Liq.  Acidi  Arsen.  V aa  3  ij 

Quinin.  Sulph.      J 

Inf us.  Cinchonae   q.s.  ad  |  iij 


This  prescription  cannot  be  called  incompatible.  The  tinc- 
ture, the  solution,  and  the  infusion  all  contain  free  acid — 
the  first  two  hydrochloric,  the  last  sulphuric  (aromatic).  The 
quinine  is  dissolved  by  the  free  acids  without  any  difficulty, 
and  neither  the  iron  nor  the  arsenic  will  be  precipitated. 
There  is  a  darkening  in  color,  however,  due  to  the  action  of 
the  cinchotannic  acid  on  the  iron ;  but  even  that  is  prevented 
to  a  certain  extent  by  the  acid. 

125.     Tr.  Ferri  Chlor.  ^ 

Tr.  Nuc.  Vom.     I   aa  10.0 

Tr.  Digitalis       J 


80  PRESCRIPTION  INCOMPATIBILITIES 

Chinin,  Sulph.l  go 

Natrii  Salicyl.J" 

Spir.   Ammon.   Arom 20.0 

Syr.Aurant.Cort.-i  ,.aa75.0 

Aquae  J 

This  is  a  prescription  calculated  to  ruffle  the  equanimity 
and  upset  the  equilibrium  of  the  most  placid  of  druggists. 
The  different  incompatibilities  and  reactions  which  are  apt 
to  take  place  in  it  are  as  follows:  (1)  The  tincture  of  digi- 
talis will  make  a  black  mixture  with  the  iron,  producing  fer- 
ric tannate ;  (2)  the  tincture  of  nux  vomica  will  do  the  same 
thing;  (3)  syrup  of  orange  peel  also  contains  tannin,  and 
will  produce  a  similar  effect;  (4)  the  sodium  salicylate  reacts 
with  the  iron,  producing  ferric  salicylate  of  a  deep  violet-blue 
color;  (5)  the  salicylate  reacts  with  the  quinine  sulphate, 
which  is  dissolved  by  the  tincture  of  iron,  producing  the 
sticky,  bulky  quinine  salicylate;  (6)  .the  aromatic  spirit  of 
ammonia,  containing,  as  it  does,  free  ammonia  and  ammonium 
carbonate,  will  react  with  the  ferric  chloride,  producing  a 
magma  of  ferric  hydroxide  and  carbonate,  which  latter  is 
soon  converted  into  oxide;  (7)  the  spirit  of  ammonia  also 
reacts  with  the  quinine  sulphate,  precipitating  the  free  alka- 
loid quinine,  and  is  apt  also  (8)  to  precipitate  strychnine  and 
brucine  from  the  tincture  of  nux  vomica.  In  one  instance 
that  the  writer  recalls,  before  an  attempt  was  made  to  make 
up  the  prescription,  the  physician  was  consulted;  but  he 
said  it  should  be  made  up  as  written.  The  druggist  did  so; 
but  such  an  awful  looking,  sticky,  pasty  mess  was  obtained, 
with  some  dirty-looking  liquor  floating  above,  that  of  dis- 
pensing it  there  could  be  no  question.  It  is  impossible  to 
make  it  up  with  all  the  ingredients  in  any  presentable  man- 
ner. One  of  two  ways  is  open :  either  to  leave  out  the  sodium 
salicylate,  or  to  leave  out  both  the  quinine  sulphate  and  the 
sodium  salicylate,  and  use  quinine  salicylate  instead.  Even 
with  this  modification  a  good  deal  of  judgment  is  necessary 


PRESCRIPTION  INCOMPATIBILITIES  81 

in  order  to  compound  the  mixture  correctly.  The  proper 
procedure  is  as  follows :  Add  the  aromatic  spirit  of  ammonia 
to  the  syrup ;  to  this  add  at  once  the  tincture  of  ferric  chlo- 
ride— no  or  hardly  any  precipitation  will  take  place,  as  con- 
centrated syrup  prevents  the  precipitation  of  ferric  salts  by 
ammonia.  Add  now  the  tincture  of  nux  vomica  and  digitalis ; 
the  mixture  turns  black,  but  there  is  no  precipitate  worth 
mentioning.  Put  the  quinine  sulphate  (or  the  quinine  sali- 
cylate,  if  that  has  been  taken,  which  course  is  advisable)  in 
a  mortar,  and  incorporate  it  well  with  the  mixture  gradually 
added.  Finally,  add  the  water;  or  still  better,  use  about  V& 
or  1/2  of  glycerin  and  the  balance  water — precipitation  will 
thereby  be  more  surely  prevented.  The  mixture  thus  ob- 
tained is  not  of  too  elegant  an  appearance,  but  can  be  poured 
easily,  does  not  taste  abominably,  and  is  good  enough  for 
practical  purposes.  It  is  unnecessary  to  say  that  it  must  be 
dispensed  with  a  "shake  well"  label;  the  bottle  should  also 
be  kept  on  the  side. 

126.  Diuretin  3  j 

Tr.  Ferri  Chloridi  3  ij 

Syrupi   3  j 

Aquae,  q.  s ad   $  ij 

If  you  know  the  chemical  composition  of  diuretin,  you  will 
have  no  difficulty  in  making  out  the  incompatibility.  Diure- 
tin is  chemically  theobromine-sodium  and  sodium  salicylate ; 
of  the  formula  C7H7NaN402 .  NaC7H503.  (One  atom  of 
hydrogen  in  the  theobrornine  is  replaced  by  an  atom  of  so- 
dium, and  this  compound  is  united  to  a  molecule  of  sodium 
salicylate).  A  deep  violet-blue  solution  results,  due  to  the 
formation  of  ferric  salicylate.  Furthermore,  some  theobro- 
mine  is  liberated  and  precipitated  by  the  free  acid  which  is 
present  in  the  tincture. 

127.  Diuretin 3  ij 

Aquae 3  vj 

I  once  ordered  this  mixture  and  instead  of  getting  a  per- 


82  PRESCRIPTION  INCOMPATIBILITIES 

fectly  clear  solution  as  I  expected,  I  got  a  milk-white  mixture 
similar  to  chalk  mixture.  On  making  an  inquiry,  I  found 
that  genuine  diuretin  was  dispensed,  but  the  bottle  (one- 
third  full)  had  been  standing  on  the  shelf  for  over  two  years. 
The  druggist  had  forgotten  whether  diuretin  was  soluble  or 
not.  I  can  think  of  no  chemical  which  is  more  easily  de- 
composed by  exposure  to  the  air  than  diuretin  is.  The  theo- 
bromine  becomes  dissociated  from  the  sodium  salicylate  and 
is  no  longer  soluble  in  cold  water.  For  this  reason  diuretin 
should  never  be  prescribed  in  powders,  as  the  air  will  decom- 
pose it  and  render  it  insoluble. 

128.     Theobromine-Sodium  Salicyl  3  iv 

Spir.  Glonoini mxxxij 

Spir.  Nitrous  Ether : 3  iv 

Ac.  Phosph.  Dil 3  ij 

Syr.  Rub.  Idaei 5  ij 

Aquae  q.  s ad    3  viij 

S. :    3  ss  every  hour  until  desired  effect  has  been  produced. 

This  seems  to  be  a  prescription  for  an  urgent  case  of  dropsy 
and  suppression  of  urine.  If  so,  it  is  a  pity  that  the  acid 
spoils  its  efficiency  and  rapidity  of  action  to  a  certain  extent. 
Theobromine-sodium  salicylate  is  incompatible  with  acids,  the 
theobromine  separating  and  precipitating  out.  Besides  the 
phosphoric  acid,  the  citric  acid  in  the  syrup  of  raspberry 
and  the  nitrous  acid  in  the  spirit  of  nitrous  ether  will  have 
the  same  tendency.  Of  course,  salicylic  acid  will  also  be 
precipitated  by  the  acids. 

While  some  pharmacists  would  dispense  the  prescription 
as  written,  it  would  be  wrong  to  do  so.  The  conscientious 
and  advanced  pharmacist  would  leave  out  the  phosphoric 
acid  (and  perhaps  also  the  syrup  of  raspberry,  substituting 
a  non-acid  syrup) ;  and  would  inform  the  physician  of  the 
changes  made,  explaining  in  detail  the  reasons  which  made 
the  changes  necessary.  I  am  certain  that  the  physician  in 
most  cases  would  be  thankful  for  the  information. 


PRESCRIPTION  INCOMPATIBILITIES  83 

129.  Tr.  lodi 5  jss 

Glycerin!    5  ij 

Aquae   3  "J 

A.:     For  swabbing  the  throat. 

Iodine  is  soluble  in  alcohol,  but  practically  insoluble  in 
water.  When  the  tincture  is  mixed  with  the  glycerin  and 
then  with  the  water,  the  iodine  precipitates.  The  efficiency 
of  the  remedy  would  then  be  greatly  impaired,  if  indeed  the 
application  of  undissolved  iodine  would  not  prove  very  irri- 
tating. There  is  an  easy  way  of  preventing  the  precipita- 
tion ;  by  adding  a  little  potassium  iodide ;  in  the  presence  of 
the  latter,  iodine  is  soluble  in  water  (like  in  Lugol's  solu- 
tion). It  occasionally  happens,  though  very  seldom,  that' a 
tincture  of  iodine  is  added  to  water  and  no  precipitate  takes 
place.  This  is  then  due  to  the  presence  of  hydriodic  acid 
and  ethyl  iodide  (traces)  in  the  tincture,  which  act  as  a  sol- 
vent for  the  iodine.  These  products — hydriodic  acid,  ethyl 
iodide  and  similar  compounds — only  form,  if  the  tincture  has 
been  kept  for  a  long  time. 

Now,  all  the  above  refers  only  to  the  old  tincture  which 
was  made  without  potassium  iodide.  The  tincture  of  the 
present  U.  S.  P.  does  contain  KI,  and  the  above  prescrip- 
tion is  therefore  a  perfectly  compatible  one. 

130.  lodi  Resubrm 2.0 

Glycerini   50.0 

M.  ft.  sol.  sec.  artem. 

S.:     gtt.  x  in  aqua  t.i.d. 

It  requires  from  50  to  60  parts  of  glycerin  to  dissolve  one 
part  of  iodine ;  only  about  half  the  amount  of  the  prescribed 
iodine  would  be  dissolved.  In  order  to  make  it  all  dissolve 
and  also  to  prevent  its  precipitation  when  added  to  water,  as 
the  physician  orders,  the  addition  of  potassium  iodide  is 
indicated.  It  is  not  only  permissible,  but  imperative.  About 
1  gram  or  15  grains  should  be  added. 


84  PRESCRIPTION  INCOMPATIBILITIES 

131.  Iodine %  ss 

Oil  Turpentine  5  VJ 

Alcohol    * 3  x 

S.:     Pro  Equo. 

This  is  a  frequent  combination,  intended,  as  is  seen  from 
the  directions,  for  a  horse.  Great  care  must  be  taken  not  to 
add  the  iodine  first  to  the  turpentine,  as  great  heat  is  evolved 
and  the  mixture  may  take  fire  or  explode;  the  iodine  is 
thereby  volatilized  as  a  violet  vapor.  The  right  procedure 
is  to  dissolve  the  iodine  in  the  alcohol,  and  then  mix  it  tvith 
the  turpentine  oil,  very  gradually  added.  The  mixture  is  not 
homogeneous,  but  separates  in  two  layers ;  there  is  not  enough 
alcohol  to  dissolve  the  turpentine,  the  latter  requiring  three 
volumes  of  alcohol  for  solution.  The  upper  layer  consists 
of  turpentine  oil.  Dispense  with  "shake"  label. 

132.  Sodii  Sulphitis 3  vi 

Ac.  Hydrochl.  Dil 3  ij-3  iv 

Tr.  Nuc.  Vom 3  iij 

Aquae   ad  3  iv 

Teaspoonful  after  meals. 

This  prescription  is  incompatible.  Sodium  sulphite  and 
a  mineral  acid  should  never  be  prescribed  together,  and  if 
prescribed  the  druggist,  if  he  knows  enough,  should  call  the 
doctor's  attention  to  the  incompatibility.  The  bad  odor  is 
due  to  the  fact  that  sulphur  dioxide,  or  sulphurous  acid  gas, 
is  evolved  through  the  action  of  the  acid  on  the  sulphite.  The 
equation  is  as  follows: 

Na»SOs+2HCl  =  2NaCl  +  SO,  +  ILO. 

Of  course,  the  peculiar  antifermentative  action  of  the  sul- 
phite is  also  lost,  because  the  SO2  gradually  volatilizes,  while 
a  portion  of  it  is  oxidized  to  sulphuric  acid. 

Do  NOT  PRESCRIBE  SULPHITES,  HYPOSULPHITES  OB  THIO- 

SULPHATES  WITH  MINERAL  AdDS. 


PRESCRIPTION  INCOMPATIBILITIES  85 

133.     Tr.  Ferri  Chlor 5  ij 

Muc.  Acaciae 

Syr.  Simpl aa  3  iv 

Aquae  Menthae q.s.  ad   §  iij 

Who  does  not  know  the  incompatibility  in  this  prescrip- 
tion? It  is  mentioned  in  some  text-books;  it  has  been  dis- 
cussed time  and  again  in  the  pharmaceutical  journals,  and 
presumably,  every  pharmacist  should  know  it;  but  there  are 
hundreds  of  pharmacists,  and  no  novices  either,  who  do  not 
know  it.  Here  is  how  a  pharmacist  put  up  the  above  pre- 
scription not  so  very  long  ago:  He  mixed  the  tincture  of 
iron  with  the  mucilage  in  a  mortar,  and  to  the  dense  gelat- 
inous mass  he  added  and  added  hydrochloric  acid  until  the 
precipitate  redissolved ;  he  then  mixed  the  solution  with  the 
syrup  and  the  water.  What  a  mess  it  was!  On  inquiry  I 
learned  that  he  was  taught  that  way  by  another  pharmacist, 
who  was  quite  proud  of  his  knowledge  as  to  how  to  dissolve 
the  precipitate  formed  by  tincture  of  iron  with  acacia.  That 
there  is  a  much  easier  and  nicer  way  which  does  not  necessi- 
tate the  unjustifiable  addition  of  a  lot  of  hydrochloric  acid 
never  seemed  to  have  entered  the  mind  of  either  teacher  or 
pupil.  It  shows  how  lack  of  interest  in  one's  work  will 
deaden  the  thinking  faculties  and  take  away  all  desire  for 
experimentation  or  initiative  of  any  kind.  The  above  pre- 
scription can  be  made  up  without  the  least  trouble,  so  as  to 
give  a  clear,  transparent  solution,  by  simply  mixing  first 
the  tincture  with  the  syrup,  the  mucilage  with  the  water, 
and  then  the  two  solutions  together. 
134.  Ferri  Dialysati  Liq. 
Syr.  Rubi  Idaei 

Muc.  Acaciae aa  3  j 

Aquae  Anisi J  ij 

The  remarks  made  in  regard  to  the  previous  prescription 
apply  to  this  one  as  well.  That  is,  mix  the  solution  of  the 
dialysed  iron  with  the  syrup,  the  mucilage  of  acacia  with 
the  water,  and  then  mix  the  two  solutions. 


86  PRESCRIPTION  INCOMPATIBILITIES 

135.     Salol   3  ij 

Spir.  Aeth.  Nitrosi 3  J 

Tr.  Ferri.  Chloridi 3  ij 

Glycerin!   §  ss 

Aquae  Jv 

Salol  is,  chemically,  phenyl  salicylate,  C6H5C7H5O3.  When 
added  to  the  spirit  of  nitrous  ether  it  dissolves ;  on  now  add- 
ing the  tincture  of  iron  a  deep  violet-blue  solution  results, 
due  to  the  formation  of  ferric  salicylate,  and  partly  also  to 
the  action  of  the  phenyl  radicle  on  the  ferric  salt.  On  adding 
the  glycerin  no  change  is  noticed;  if  anything,  the  mixture 
gets  still  darker.  On  adding  the  water,  the  mixture  becomes 
at  once  very  turbid,  and  the  deep-violet  color  is  changed  to 
a  dirty  yellowish-white.  The  turbidity  is  due  to  the  precipi- 
tation of  the  salol  by  the  water,  in  which  menstruum  salol  is 
insoluble.  The  mixture  does  not  remain  permanently  the 
same,  but  undergoes  a  notable  change  on  standing;  the  salol 
precipitates,  sticking  to  the  sides  and  bottom  of  the  bottle, 
while  the  supernatant  liquid  is  perfectly  transparent  and  of 
a  pale-violet  color.  The  prescription  should  not  be  dispensed 
until  the  prescriber  has  been  made  acquainted  with  the  diffi- 
culty. 

13G.     Zinei  lodidi gr.  xv 

Aquae  §  ij 

S.:    3  j  ter  in  die. 

I  received  this  prescription  with  the  request  to  explain 
the  reason  for  the  precipitation  that  took  place  on  dissolv- 
ing the  zinc  iodide.  My  correspondent  wrote  that  he  at  first 
dissolved  the  salt  in  plain  water ;  then,  thinking  the  precipi- 
tate might  be  due  to  the  impurities  and  the  carbon  dioxide 
in  the  water,  he  took  distilled  water  and  boiled  it;  but  the 
result  was  the  same;  there  was  a  flocculent  precipitate,  or 
rather  sediment,  floating  about.  This  is  a  frequent  occur- 
rence with  zinc  iodide;  in  fact,  it  always  take  place  unless 
the  salt  has  been  made  but  a  short  time  and  has  been  kept 


PRESCRIPTION  INCOMPATIBILITIES  87 

in  a  small  bottle  with  a  ground-glass  stopper.  The  reason 
is  a  simple  one :  Zinc  iodide  is  not  a  very  stable  salt.  It 
easily  loses  iodine  and  has  a  great  avidity  for  oxygen.  There- 
fore, there  is  but  seldom  a  sample  of  zinc  iodide  to  be  found 
in  the  drug-stores  that  does  not  contain  a  small  amount  of 
zinc  oxide  or  zinc  oxyiodide.  The  only  thing  to  do  is  to 
filter  the  solution.  (If  the  dispenser  wants  to  be  strictly  con- 
scientious, it  is  well  to  take  2  or  3  grains  more  than  pre- 
scribed, so  as  to  make  up  the  loss  occasioned  by  the  filtra- 
tion.) 

137.  Aquae  Aram.  Fort. 

Collodii  : aa  3  ij 

S. :  Apply  to  warts  with  camel's-hair  brush. 
This  prescription  was  handed  me  with  the  remark  that 
the  mixture  became  solidified,  and  with  the  question  if  ammo- 
nia water  was  incompatible  with  collodion.  It  is  not  the 
ammonia  gas  that  is  at  fault  here,  but  the  water.  Collodion 
is  a  solution  of  gun-cotton  (pyroxylin  or  di-nitro-cellulose) 
in  a  mixture  of  alcohol  and  ether,  and  is  precipitated  by 
water.  If  plain  water  is  used  instead  of  the  ammonia  water 
the  result  is  the  same.  An  alcoholic  solution  of  ammonia 
(like  the  formerly  official -"spiritus  ammoniac, "  not  "spiritus 
ammoniac  aromaticus")  would  answer  the  purpose;  but  it  is 
so  seldom  found  in  the  average  drug-store,  that  difficulty  is 
likely  to  be  encountered  in  having  the  prescription  com- 
pounded properly. 

138.  Collodii   3  J 

Aetheris    5  8S 

Aq.  Ainmon.  Fort 3  J 

Tr.  lodi 3  iss 

By  a  strange  coincidence,  no  sooner  had  I  disposed  of  the 
previous  prescription  than  I  was  requested  to  criticize  the 
above.  The  druggist  had  dispensed  it  without  giving  it  a 
thought,  as  at  first  it  looked  all  right;  but  there  really  wae 
very  much  the  matter  with  it.  The  reason  that  no  precipita- 


88  PRESCRIPTION  INCOMPATIBILITIES 

tion  was  noticed  at  once  was  due  to  the  extra  ether  entering 
into  the  prescription ;  but  after  a  while  the  pyroxylin  is  pre- 
cipitated out  completely.  That  is  not  all,  however.  The 
iodine  combines  with  the  ammonia  to  form  ammonium  iodide 
and  iodate;  and  it  is  due  to  this  fact  that  the  odor  of  the 
ammonia  very  quickly  disappears  (almost  completely).  There 
being  in  this  prescription  an  excess  of  iodine,  the  mixture  is 
brown  at  first,  but  gradually  it  becomes  lighter,  until  in  a 
short  time  it  is  perfectly  colorless.  Undoubtedly  the  excess 
of  the  iodine  combines  with  the  ether  to  form  ethyl  iodide. 
What  is  obtained  in  the  end  ?  A  little  cotton  at  the  bottom  of 
the  bottle,  with  a  supernatant  solution  of  ammonium  iodide 
and  iodate  (in  an  ethereo-alcoholic  medium).  The  prescrip- 
tion, as  written,  should  not  be  dispensed,  because  both  the 
protective  value  of  the  collodion  and  the  counter-irritant 
effect  of  the  iodine  are  entirely  destroyed.  If  the  ammonia 
water  is  omitted  the  prescription  is  all  right  in  every  respect. 
As  the  ammonia  disappears  anyhow  (from  its  combining  with 
the  iodine),  there  can  be  no  objection  to  that  course;  but  the- 
physician  should  be  informed  of  the  change  made. 

139.    Plurnbi  Acetatis  3  i 

Glyceriti  Ac.  Tannici  3  iij 

Aquae  3  iss 

"Is  this  prescription  incompatible  and  would  I  have  been 
right  in  refusing  to  dispense  it  ? "  was  a  query  put  to  me  re- 
cently. It  should  be  remembered  that  the  words  "incompati- 
ble" and  "non-dispensable"  are  not  synonymous.  A  pre- 
scription may  be  incompatible,  but  as  long  as  it  is  not  danger- 
ously poisonous  or  explosive,  and  it  can  be  poured  from  the 
bottle  (if  a  mixture),  we  may  dispense  it — if  the  physician 
so  desires.  There  is,  of  course,  no  question  as  to  the  incom- 
patibility of  the  prescription.  Insoluble  lead  tannate  is 
formed,  and  of  course,  precipitates.  If  the  proportions  are 
large  an  almost  solid  mass  is  formed.  Whether  to  dispense  it 
as  written  or  to  inform  the  physician  depends  a  great  deal 


PRESCRIPTION  INCOMPATIBILITIES  89 

on  the  directions.  If  it  is  to  be  applied  externally,  with  lint, 
etc.,  there  can  be  no  objection  to  its  being  dispensed — many 
physicians  believe  lead  tannate  to  be  an  excellent  remedy 
in  phlegmasia  dolens,  epididymitis,  buboes,  etc. ;  but  if  the 
mixture  is  to  be  used  as  a  gargle,  for  instance,  I  would  advise 
informing  the  physician. 

140.  Zinci  Chloridi gr.  xx 

Collodii    3  iij 

S. :     Apply  to  corn  with  camel's-hair  brush. 

The  druggist,  anticipating  some  difficulty  in  dissolving  the 
zinc  chloride  directly  in  the  collodion,  dissolved  the  salt  in 
about  half  a  dram  of  water  and  mixed  it  with  the  collodion ; 
thus  converting  it  into  a  useless  mass.  The  right  way  is  to 
dissolve  the  chloride  in  a  little — a  few  drops — alcohol  (in 
which  it  is  very  soluble),  and  then  mix  the  solution  with  the 
collodion.  I  have  seen  another  druggist,  wishing  to  put  up 
an  effective  corn  cure,  mix  liquor  potassii  hydroxidi  with 
collodion,  and  thus  spoil  8  ounces  of  the  latter. 

141.  3  Tr.  Nucis  Vom. 

4  Tr.  Digitalis 

1  Tr.  Ferri  Chloridi  . 

2  Ac.  Phosph.  Dil aa  3  ij 

5  Aquae 3  ij 

This  mixture  will  present  a  somewhat  different  appearance, 

according  to  the  manner  in  which  the  ingredients  are  mixed. 
I  know  of  a  case  where  ignorance  of  this  fact  cost  the  drug- 
gist a  valuable  customer.  If  the  ingredients  are  mixed  in  the 
order  in  which  they  are  written,  a  somewhat  dark  and  turbid 
mixture  is  obtained.  The  tannin  of  the  first  two  ingredients 
produces  the  tannate  of  iron,  which  is  in  turn  decomposed 
by  the  phosphoric  acid.  If  the  phosphoric  is  first  added'  to 
the  tincture  of  iron,  a  perfectly  colorless  solution  is  the  re- 
sult, due  to  the  formation  of  acid  ferric  phosphate.  On  now 
adding  the  tinctures,  a  much  lighter  and  clearer  solution  is 
obtained.  The  druggist,  above  referred  to,  forgot  the  order 


90  PRESCRIPTION  INCOMPATIBILITIES 

in  which  he  mixed  the  ingredients  the  first  time,  and  on  re- 
newal the  mixture  had  a  different  color.  No  amount  of  argu- 
mentation would  convince  the  patient  that  no  mistake  had 
been  made.  He  said  he  preferred  to  patronize  more  careful 
druggists.  In  such  prescriptions  the  exact  order  of  mixing 
should  be  noted,  by  the  aid  of  figures,  as  shown  above. 

142.     Zinci  Phosphidi   gr.  xvi 

Ac.  Phosphor.  Dil 5  i 

Glycerin! 3  i 

Aquae  Menthae  q.s.  ad  3  ir 

S. :    3  j  three  times  a  day,  after  rneals. 

This  prescription  recalls  to  mind  an  interesting  discussion 
I  once  had  with  a  physician  regarding  the  doses  of  medicines. 
He  claimed  that  the  doses  of  all  the  medicines,  poisonous  and 
non-poisonous,  are  too  small  as  given  in  the  books.  He  cited 
many  instances  to  prove  the  truth  of  his  assertion,  and 
among  other  things  he  said:  "Here  is  zinc  phosphide.  The 
dose  as  given  in  the  books  is  from  1-16  to  i/4  of  a  grain.  Well, 
I  always  prescribe  it  in  1/2  and  1-grn.  doses,  and  have  never 
seen  any  bad  or  even  disagreeable  effects."  This  statement 
astounded  me  somewhat.  I  replied  that  I  would  never  ex- 
ceed %  grn.,  and  asked  him  in  what  form  he  prescribed  it — 
in  pill  or  capsule.  "In  solution,"  was  the  answer.  "How 
do  you  dissolve  it?"  I  asked.  "Zinc  phosphide  is  insoluble 
in  water  or  alcohol."  He  replied  that  he  never  had  any  trou- 
ble, and  showed  me  the  above  prescription.  I  could  not  re- 
frain from  smiling,  and  that  gave  him  a  clue  that  something 
was  wrong  with  his  prescription.  I /then  explained  that  in  the 
above  prescription  he  had  practically  no  zinc  phosphide  left ; 
that  the  acid  decomposed  it,  with  the  production  of  phosphine 
or  phosphoretted  hydrogen  and  zinc  phosphate,  and  that  he 
would  have  done  much  better  to  prescribe  zinc  phosphate 
from  the  start.  The  reaction  which  takes  place  may  be  ex- 
pressed by  the  following  equation; 


PEESCRIPTION  INCOMPATIBILITIES  91 

Zn,P,  +  2H1PO*  =  Zn,(POO,  +  2H.P. 


Zinc         Phosphoric    Zinc  Phosphine. 

Phosphide  Acid          Phosphate 

The  regular  tribasic  zinc  orthophosphate  is  insoluble  in 
water;  and  as  the  above  mixture  was  perfectly  clear,  it  is 
evident  that  by  the  aid  of  the  excess  of  phosphoric  acid  the 
zinc  acid  phosphate  was  formed. 

The  reaction  would  then  have  to  be  expressed  as  follows  : 

Zn,P»  +  3H.P04  =  SZnHPO*  +  2H.P. 

143.  Aloini   ...................................  gr.  ij 

Podophyllini   ..............................  gr.  ss 

Calomelanos  ..............................  gr.  v 

Pulv.  Saponis  ..........................  q.s. 

This  forms  a  strong  cholagogue  pill.  Though  the  physi- 
cian directs  that  soap  be  taken  as  the  excipient,  it  is  neither 
advisable  nor  perhaps  even  permissible  to  do  it.  Soap  is 
practically  always  alkaline,  due  to  an  excess  of  soda.  This 
latter  will  convert  the  calomel  into  mercurous  oxide  (Hg20)  ; 
and  even  assuming  that  the  latter  would  not  gradually  decom- 
pose into  metallic  mercury  and  mercuric  oxide,  it  is  certainly 
dangerous  to  take  internally.  about  5  grs.  of  mercurous  oxide. 
Another  excipient,  such  as  extract  of  gentian,  should  be 
taken.  The  black  color  noticed  while  triturating  the  calomel 
with  the  soap  is  due  to  the  above-mentioned  conversion  of 
the  calomel  into  the  black  oxide  of  mercury. 

CALOMEL,  AND  SOAP  ARE  INCOMPATIBLE. 

144.  Quin.  Sulph. 

Ac.  Tartarici  ...........................  aa  3  iss 

Potass.  lodidi  .............................  3  ijss 

Syrupi  Rub.  Idaei  .........................  3  J 

Aquae  .............................  q.s.  ad  5  iij 

In  IJ  No.  40  I  presented  a  similar  prescription,  but  dilute 
sulphuric  acid  was  used  instead  of  tartaric  acid;  the  pres- 
ence of  the  latter  produces  an  additional  precipitate,  thus 
making  a  triple  incompatibility.  If  the  quinine  sulphate  is 


92  PRESCRIPTION  INCOMPATIBILITIES 

dissolved  in  a  part  of  the  water  by  the  aid  of  the  tartaric  acid, 
and  a  solution  of  the  potassium  iodide  added  to  this,  a  fine 
crystalline  precipitate  is  immediately  formed.  This  precipi- 
tate is  not  quinine  iodide,  as  might  be  supposed  (that  is 
formed  later),  but  potassium  bitartrate. 


KI  +  H^ILOa  =  HI  +      KHC4ILO.. 

Potass.       Tartaric  Hyd-  Cream  of  Tartar. 

Iodide        Ac.  riodic  Acid. 

It  will  be  remembered  that  this  is  the  official  way  of  mak- 
ing Dilute  Hydriodic  Acid.  The  hydriodic  acid  and  the  bal- 
ance of  the  undecomposed  potassium  iodide  soon  afterward 
attack  the  quinine  sulphate,  and  precipitate  it  in  the  form  of 
quinine  hydriodide.  In  dispensing,  the  tartaric  acid  had 
best  be  left  out. 

145.  lodoformi  *i  __       .. 
Hydrarg.  Chlor.  MitisJ"  ' 

This  prescription  is  said  by  some  to  be  incompatible,  it 
being  claimed  that  iodine  is  liberated  from  the  iodoform,  con- 
verting the  calomel  into  mercuric  iodide.  I  take  exception  to 
this  statement  and  affirm  that  this  combination  is  quite  com- 
patible. Iodoform  liberates  iodine  only  when  exposed  to 
direct  sunlight  ;  and  when  such  a  powder  is  prescribed,  it  is 
not  generally  set  in  the  sun.  It  is  more  often  hidden  under  a 
bushel.  I  have  prescribed  this  combination  hundreds  of 
times,  without  ever  noticing  mercuric  iodide.  As  a  rule,  the 
powder  is  used  in  a  few  days. 

146.  Liq.  Plumbi  Subacet  .........................  3  ss 

Tr.  Opii  ...................................  3  ij 

Aquae  ..............................  q.s.  ad   3  iv 

There  is  certainly  not  a  druggist  who  has  not  at  some  time 
or  another  dispensed  this  prescription.  Though  strictly  in- 
compatible, it  is  nevertheless  dispensed  daily  ;  and  as  it  seems 
to  give  good  results  to  both  physician  and  patient,  we  must 
not  object.  The  incompatibility  is  a  double  one;  lead  being 


PRESCRIPTION  INCOMPATIBILITIES  93 

an  alkaloidal  precipitant,  precipitates  the  alkaloids  of  the 
opium ;  another  portion  of  it  combines  with  the  meconic  acid 
present  in  the  opium  tincture  and  precipitates  as  lead  meco- 
nate.  In  the  case  where  lead  acetate  is  used  instead  of  the 
subacetate  (as  it  is  in  the  National  Formulary — see  "Lotio 
Plumbi  et  Opii"),  the  precipitate  is  not  quite  so  heavy. 

147.  Hydrarg.  Chlor.  Mitis gr.  iij 

Ammon.  Carbon gr.  v 

Sacch.  JL/actis gr.  v 

M.  et  ft.  pulv.  No.  1.  Tal.  dos.  No.  xxiv. 

There  is  no  positive  proof  on  hand  that  a  very  poisonous 
compound  is  formed  on  mixing  the  above  ingredients;  never- 
theless it  is  better  to  be  on  the  safe  side,  and  not  dispense  this 
prescription.  When  the  ammonium  carbonate  and  calomel  are 
rubbed  together  the  color  of  the  powder  is  changed  to  black. 
This  black  color  is  due  to  the  formation  of  mercurous  oxide 
(Hg2O)  and  ammonium  mercurous  chloride  (NH2Hg2Cl) 
and,  taking  into  consideration  the  instability  of  the  mercur- 
ous compounds,  there  can  hardly  be  any  doubt  that  within 
a  short  time  a  portion  of  them  will  lose  the  extra  atom  of 
metallic  mercury  and  pass  into  the  mercuric  state. 

148.  Sol.  Labarraque 

Sol.  Hydrogenii  Peroxidi aa  75.0 

S. :     Apply  to  throat  and  nose  with  cotton  swab. 

The  activity  of  Labarraque 's  solution,  or  solution  of  chlori- 
nated soda,  depends  upon  the  presence  therein  of  sodium  hy- 
pochlorite,  which  is  easily  decomposed,  yielding  chlorine.  In 
the  presence  of  the  peroxide  the  hypochlorite  becomes  re- 
duced, according  to  the  following  equation : 
NaCIO  +  H,0>  =  NaCl  +  ILO  +  02. 

As  is  seen,  the  peroxide  becomes  reduced  to  water  at  the 
same  time.  The  prescription  or  a  part  of  it  therefore  be- 
comes practically  worthless. 

HYDROGEN  DIOXIDE  SHOULD  NOT  BE  PRESCRIBED  WITH  So- 


94  PRESCRIPTION  INCOMPATIBILITIES 

LUTION  OF  HYPOCHLORITES   (LABARRAQUE'S  SOLUTION  OR  JA- 
VELLE  WATER). 

149.    Morphin.  Snlph gr.  ij 

Antikamnia 3  ij 

Quinin.  Sulph 3  j 

Syr.  Tolut 3  iij 

Ac.  Sulph.  Arom q.s. 

Aquae    ad   3J 

Teaspoonful  when  required. 

This  prescription  forcibly  illustrates  a  tendency  which 
cannot  be  condemned  in  too  severe  terms:  the  habit  which 
some  physicians  have  of  prescribing,  in  combination  with  offi- 
cial or  other  well-known  remedies,  proprietary  compounds, 
the  exact  composition  of  which  is  not  known  to  them.  How 
can  the  prescriber  be  certain  that  the  proprietary  article  does 
not  react  with  the  other  remedies,  possibly  with  a  deleterious 
result  to  both  ?  How  can  the  druggist  be  in  a  position  to  pre- 
vent or  correct  an  incompatibility?  How  can  the  physician 
know  to  which  drug  to  ascribe  beneficial  results,  following 
the  administration  of  such  a  combination?  Suppose  the  pa- 
tient was  relieved  by  the  above  mixture ;  how  does  the  physi- 
cian know  whether  the  relief  was  due  to  the  morphine  and 
quinine,  or  to  the  antikamnia?  I  remember  one  physician 
used  to  praise  to  heaven  a  certain  alterative  compound;  it 
was  "the  anti-syphilitic  par  excellence."  Yet  he  used  to  pre- 
scribe it  invariably  in  conjunction  with  the  iodides  and  mer- 
curials. I  once  asked  him  whether  the  therapeutic  virtues, 
he  thought  the  proprietary  preparation  possessed,  might  not 
be  ascribed  to  those  drugs ;  but  he  still  owes  me  the  answer. 
To  return  to  the  above  prescription.  If  the  quinine  is  dis- 
solved by  the  aid  of  the  acid,  and  the  antikamnia  is  then 
added,  effervescence  takes  place,  due  to  the  evolution  of  car- 
bon dioxide.  Whether  precipitation  will  take  place  or  not, 
will  depend  upon  the  amount  of  sulphuric  acid.  If  enough  is 
present  to  neutralize  all  the  bicarbonate  of  the  antikamnia, 
none  will  take  place ;  but  if  an  insufficient  quantity  is  taken, 


PRESCRIPTION  INCOMPATIBILITIES  95 

the  bicarbonate  precipitates  the  morphine  and  the  quinine, 
and  the  prescription  then  is  a  dangerous  prescription  to  dis- 
pense. The  bulk  of  the  antikamnia,  i.  e.,  the  acetanilid,  will 
in  any  case  remain  undissolved. 

150.  Hydrarg.  Chlor.  Mitis 3  ij 

Hydrogenii  Peroxidi 3  ij 

S. :  Apply  externally  three  times  a  day. 
The  statement  is  generally  made  that  hydrogen  dioxide 
oxidizes  or  otherwise  changes  mercurous  into  mercuric  salts. 
This  may  be  true  of  soluble  mercurous  salts,  such  as  mercur- 
ous nitrate  (I  did  not  investigate  that  subject,  as  the  only 
mercurous  salt  used  in  medicine  is  an  insoluble  one),  but  it 
must  be  accepted  with  great  reservation  as  regards  calomel. 
I  shook  calomel  with  hydrogen  dioxide  for  many  hours,  and 
failed  to  detect  any  mercuric  chloride.  This  assertion  must 
therefore  be  based  upon  the  following  careless  observation: 
When  hydrogen  dioxide  is  kept  in  contact  with  calomel  and 
filtered,  the  filtrate  will  give  quite  an  abundant  precipitate 
with  silver  nitrate  solution ;  a  precipitate  soluble  in  ammonia 
water  and  re-precipitated  by  nitric  acid.  This  shows  the 
presence  of  a  soluble  chloride  in  the  filtrate,  beyond  all 
doubt.  On  further  investigation  we  discover  that  even  be- 
fore being  shaken  with  calomel,  the  peroxide  gives  a  white 
precipitate  of  silver  chloride,  because  the  commercial  article 
always  contains  soluble  chlorides.  On  testing  the  filtrate  with 
KOH,H2S,  or  copper,  or  any  other  delicate  test  for  mercury, 
none  is  discoverable.  It  is  possible  that  on  very  prolonged 
contact,  some  bichloride  may  be  formed ;  but  then  the  decom- 
position may  be  due  to  other  causes,  such  as  light,  etc.  We 
may  safely  assert,  however,  that  calomel  and  hydrogen  diox- 
ide are  not  incompatible. 

151.  Hydrogenii  Peroxidi %  ij 

Sol.  Hydrarg.  Bichloridi  1 :1000 3  iv 

S. :     Apply  externally  with  cotton  swab. 
This  prescription  is  all  right.    I  have  tested  this  solution 


96  PRESCRIPTION  INCOMPATIBILITIES 

both  therapeutically,  on  patients,  and  chemically.  The  anti- 
septic effect  was  not  in  any  way  diminished,  and  chemical  tests 
failed  to  discover  any  change  either  in  the  peroxide  or  in  the 
corrosive  sublimate. 

152.  lodof ormi   3  j 

Aq.  Hydrogenii  Perox |  J 

The  combination  is  an  odd  one,  but  not  incompatible. 
Careful  tests  failed  to  discover  any  decomposition  in  the 
iodoform.  The  insolubility  of  the  iodoform  in  the  menstruum 
prevents  the  action  of  the  peroxide  on  it.  If  the  iodoform  is 
in  solution,  then  peroxide  of  hydrogen  does  decompose  it,  as 
will  be  seen  from  the  next  prescription. 

153.  lodof  ormi 3  ss 

Aetheris  Sulphurici  5  ss 

Aq.  Hydrogenii  Peroxidi 3  ij 

This  prescription  is  incompatible.  The  iodoform  dissolves 
in  the  ether,  and  on  mixing  the  solution  with  the  peroxide, 
iodine  is  liberated,  as  can  be  ascertained  by  adding  gelatin- 
ized starch,  when  a  deep-blue  color  is  developed.  Of  course, 
the  red-colored  ethereal  solution  is  not  miscible  with  the 
H202  solution. 

154.  Kali  Hypermangan 0.5 

Argenti  Nitratis 1.5 

Aquae  Destillatae   25.0 

The  potassium  permanganate  dissolves  readily  in  water 
and  so  does  the  silver  nitrate;  but  on  mixing  the  two  solu- 
tions a  precipitate  of  silver  permanganate  will  form,  the  lat- 
ter being  soluble  only  in  about  15  parts  of  water,  according 
to  my  investigations.  Of  course,  the  silver  permanganate  will 
not  remain  long  as  such,  it  being  soon  decomposed  into  silver 
oxide,  metallic  silver,  potassium  manganate  and  manganese 
dioxide  (or  manganese  hydroxide). 

155.  Sod.  Salicyl 3  v 

Sod.  Bicarbon 3  iij 

Aquae  Menth.  Pip 3  iv 


PRESCRIPTION  INCOMPATIBILITIES  97 

The  patient  should  be  told  that  the  medicine  will  darken 
after  a  while,  so  that  there  will  be  no  cause  for  alarm.  A 
solution  of  commercial  sodium  salicylate  always  gets  some- 
what brownish,  and  especially  does  the  color  develop  in  the 
presence  of  an  alkali. 

156.  Magnes.  Sulph 5  iJ85 

Spts.  Menth.  Pip %  iss 

Aquae   5  "J 

S. :     Two  teaspoonfuls  every  4  hours. 

There  is  just  about  enough  water  in  this  prescription  to 
dissolve  the  magnesium  sulphate.  It  will  be  a  fully  saturated 
solution.  But  on  adding  the  spirit  of  peppermint,  the  entire 
mixture  becomes,  so  to  say,  solid,  the  magnesium  sulphate 
being  thrown  out  of  solution.  Does  any  chemical  reaction 
take  place?  None  at  all.  It  is  a  purely  physical  process. 
The  MgSO4  is  insoluble  in  alcohol;  the  latter,  besides,  pos- 
sesses strong  hygroscopic  properties,  and  abstracts  the  water 
from  the  salt.  This  salt,  having  no  solvent  in  which  to  keep 
dissolved,  precipitates  out. 

A  SATURATED  SOLUTION  OP  MAGNESIUM  SULPHATE  SHOULD 
NOT  BE  PRESCRIBED  WITH  ALCOHOLIC  LIQUIDS. 

157.  Hydrarg.  Chlor.  Mit gr.  ij 

Antipyrine  3  ss 

Sod.  Bicarb 3  ij 

M.  et  ft.  pulv.  No.  xij.    S.:    One  every  hour. 

In  one  of  the  early  prescriptions  (No.  37)  it  was  stated  that 
when  calomel  is  triturated  with  antipyrine,  some  corrosive 
sublimate  is  formed.  The  following  reaction  is  supposed  to 
take  place : 

6Hg  Cl  +  2CuH«N.O  +  H,0  =  Hg*0  -f 
Calomel       Antipyrine      Water    Mercurous  oxide 
2  HgCla  +  Hg,  +  2CnIL2N2O.HCl. 
Mercuric      Metallic      Antipyrine 
Chloride     Mercury     hydrochloride 


98  PRESCRIPTION  INCOMPATIBILITIES 

Pains  were  taken  to  explain  that,  as  but  a  small  propor- 
tion of  the  calomel  (one-tenth  or  less)  is  converted  into  cor- 
rosive sublimate,  little  hesitation  need  be  felt  in  dispensing 
calomel  and  antipyrine,  when  the  former  is  prescribed  in 
small  doses,  as  fractional  parts  of  a  grain.  The  above  pre- 
scription may  be  dispensed  with  safety,  as  the  prescribed  dose 
of  the  calomel  is  but  1-6  grain,  and  the  sublimate  that  will 
form  will  not  exceed  1-60  or  1-100  grain. 

As  to  the  incompatibility  between  the  calomel  and  the  so- 
dium bicarbonate,  the  author  considers  it  imaginary.  At  any 
rate,  for  practical  purposes,  it  may  be  disregarded  alto- 
gether, as  even  some  of  those  who  claim  that  the  two  chem- 
icals are  incompatible,  say  that  it  takes  from  six  to  eight 
weeks  before  any  corrosive  sublimate  is  formed.  Far  from 
considering*  them  incompatible,  I  together  with  the  entire 
medical  profession,  consider  calomel  and  sodium  bicarbonate 
a  very  eligible  combination.  When  calomel  is  prescribed  in 
large  doses,  the  tendency  to  griping  seems  to  be  distinctly 
obviated  by  the  addition  of  a  little  sodium  bicarbonate. 

158.  Morph.  Hydrochl gr.  ij 

Potass.  Cyanidi  gr.  ij 

Syr.  Ipecac  3  ij 

Vin.  Antimonii  3  ij 

Syr.  Tolutani  3  ss 

Aquae q.s.  ad  3  ij 

S.:     3  j  q.  4  h. 

This  mixture,  which  was  dispensed  without  a  shake  label, 
caused  quite  alarming  symptoms  towards  the  end.  The  symp- 
toms were  those  of  an  overdose  of  morphine,  combined  with 
those  of  an  excess  of  cyanide.  The  potassium  cyanide  reacts 
with  the  morphine  salt,  precipitating  it  as  morphine  cyanide ; 
and  a  small  portion  may  be  precipitated  as  free  morphine  by 
the  potassium  carbonate,  which  is  usually  present  in  potas- 
sium cyanide.  It  is  best  not  to  dispense  this  mixture.  If 
it  is,  a  shake  label  should  accompany  it  invariably. 


PRESCRIPTION  INCOMPATIBILITIES  99 

159.  Mercauro  §  j 

Strychn.  Nitratis  gr.  iij 

Atropinae  Sulphatis  gr.  ij 

S.:     Ten  drops  in  water,  four  times  a  day. 

This  very  potent  prescription,  which  again  illustrates  the 
reprehensible  desire  of  some  physicians  to  get  half  a  dozen 
physiologic  effects  out  of  the  same  bottle,  was  presented  to 
a  druggist  a  few  days  ago.  He  knew  enough  to  refuse  to 
dispense  it  as  written  and  to  inform  t^e  prescriber  that  it 
would  make  a  dangerous  combination.  The  bromides  of  gold 
and  mercury  present  in  mereauro  will  precipitate  the  alka- 
loids. 

160.  Ferri  et  Quin.  Citr.  Solub 3  ij 

Liq.  Ammon.  Acetatis *. . .  %  ij 

Syrupi   5  ss 

Aquae  3  *v 

On  dissolving  the  iron  and  quinine  citrate  in  the  water  and 
adding  the  solution  of  ammonium  acetate,  a  white  precipitate 
is  noticed.  The  precipitate  is  not  due  to  the  iron  in  this  case, 
as  ferric  acetate  is  very  soluble,  and  ferric  citrate  is  not  pre- 
cipitated by  ammonia  water.  The  precipitate  which  grad- 
ually forms  is  quinine  acetate.  If  the  solution  of  ammonium 
acetate  be  strongly  alkaline,  i.  e.,  if  it  contain  an  excess  of 
ammonium  carbonate,  a  portion  of  the  quinine  citrate  will 
be  precipitated  as  alkaloidal  quinine.  At  best  it  is  a  very 
inelegant  combination. 

161.  Salis  Seignetti 3  iss 

Tr.  Ferri  Sesquichlor 3  iij 

Spiritus  Nitr.  Dulc $  j 

Syrupi  Tolutani  3  ^ 

Aquae  Fontanae 3  v 

M.D.S.:     Cochlear  magnum  ter  in  die  post  cibum. 

This  is  the  prescription  of  an  old  physician,  which  I  made 
up  a  number  of  times.  Sal  Seignette  is  another  name  for 
Rochelle  salt.  (Seignette  was  an  apothecary  in  Rochelle  who 


100          PRESCRIPTION  INCOMPATIBILITIES 

first  introduced  this  double  tartrate  of  potassium  and  so- 
dium.) On  dissolving  the  Rochelle  salt  in  the  water  and  mix- 
ing with  the  other  ingredients  the  mixture  becomes  turbid, 
and  within  a  few  seconds  a  heavy  crystalline  precipitate 
forms.  The  solution  of  the  problem  is  very  simple.  The 
tincture  of  iron  contains  a  considerable  amount  of  free  hy- 
drochloric acid.  This  acid  (and  also  the  nitrous  acid  usually 
found  in  spirit  of  nitrous  ether)  decomposes  the  Rochelle 
salt,  with  the  formation  of  sodium  chloride  and  cream  of 
tartar,  which  latter  precipitates.  The  reaction  may  be  shown 
as  follows: 

KNaCiILOe  +  HC1  =  NaCI  +  KHCJLOe. 

The  alcohol  in  the  iron  tincture  and  the  spirit  aid  in  the 
precipitation,  as  potassium  bitartrate  is  almost  absolutely 
insoluble  in  alcohol.  The  iron  has  nothing  to  do  with  the 
reaction.  It  is  true  that  a  solution  of  ferric  chloride  also 
decomposes  Rochelle  salt,  but  not  because  it  is  iron,  but  be- 
cause it  is  strongly  acid  (containing  some  free  HC1). 

162.  Aquae  Hydrog.  Peroxidi 3  iv 

Glycerini   ; 3  i j 

Ac.  Hydrochlor.  Dil 3  i 

S.:    3  ij  after  each  meal. 

A  druggist  refused  to  dispense  the  above  prescription 
because  he  read  somewhere  that  peroxide  of  hydrogen  and 
glycerin  were  incompatible.  In  fact  such  a  statement  has 
been  made  a  number  of  times  in  pharmaceutical  journals. 
The  statement  is  false.  Hydrogen  dioxide  and  glycerin  are 
perfectly  compatible  in  any  proportions,  and  the  mixture 
does  not  deteriorate  even  after  standing  for  months. 

163.  Hydrogenii  Perox 10.0 

Ac.  Chromici 1.0 

S. :     Caustic.    For  doctor's  use  only. 

The  doctor  could  just  as  well  have  allowed  this  "caustic" 
into  the  patient's  hands,  as  it  was  no  longer  caustic  and 


PRESCRIPTION  INCOMPATIBILITIES          101 

was  powerless  for  harm  or  for  good.  This  prescription  illus- 
trates beautifully  the  remarkable  property  of  hydrogen  per- 
oxide to  exercise  first  its  oxidizing,  then  its  reducing  power 
on  the  same  substance.  On  mixing  the  above  substances  a 
blue  color  is  at  once  formed,  due  to  the  oxidation  of  the 
chromic  acid  (chromic  trioxide)  into  perchromic  acid  (chro- 
mic pentoxide),  but  soon  the  blue  color  disappears,  and  a 
brownish  amorphous  powder  precipitates.  This  precipitate 
is'  chromium  sesquioxide,  formed  by  the  reduction  of  the 
perchromic  acid.  The  following  two  reactions  make  the 
changes  plain: 

CrO.     +2H,0*       =  CrO.          +2ILO, 
Chromic      Hydrogen      Perchromic      Water 
Acid  Diox.  Acid 

CrO.  +  3H.O,  =  CR,0.  +  SILO  +  50, 
Perchromic  Chrom.     Water     Oxygen 

Acid  Sesquiox. 

This  evolution  of  oxygen  is  quite  abundant,  as  can  be 
demonstrated  by  applying  a  glowing  match  to  the  mouth  of 
the  bottle  or  test-tube. 

164.     Hydrarg.  Bichlor.  Coir gr.  iij 

Sodii  Boratis 3  iss 

Aquae  Destill q.s.  ad      3  "J 

In  one  week  the  writer  received  two  prescriptions  like  the 
above ;  they  both  came  from  Brooklyn  pharmacists,  and  orig- 
inated from  the  same  physician.  On  dissolving  the  salts  and 
mixing  the  solutions,  a  brownish-red  precipitate  forms,  con- 
sisting of  mercury  oxychloride,  with  probably  some  mercury 
borate.  There  is  no  mercury  left  in  the  supernatant  liquid, 
as  is  shown  by  applying  the  various  tests  for  mercury.  How 
can  this  precipitation  be  prevented?  We  studied  the  prop- 
erties of  borax  and  its  behavior  with  glycerin  in  previous 
prescriptions.  We  know  that  glycerin  decomposes  borax  into 
boric  acid  and  sodium  metaborate.  On  adding  some  glycerin 
to  the  solution  of  the  borax  and  then  adding  the  corrosive 
sublimate,  no  red  precipitate  will  be  formed.  In  fact,  it 


102         PRESCRIPTION  INCOMPATIBILITIES 

might  seem  at  first  that  with  this  modification  the  prescrip- 
tion is  all  right.  But  it  is  not.  After  a  short  while  a  slight 
whitish  precipitate  will  be  found  throughout  the  liquid  and 
at  the  bottom  of  the  vessel.  Whether  this  is  mercury  meta- 
borate,  or  whether  it  is  due  to  the  impurities  present  in  com- 
mercial borax,  has  not  been  determined;  the  prescription 
should  not  be  dispensed.  The  only  way  out  of  the  difficulty 
is  to  substitute  boric  acid  for  borax ;  on  mixing  HgCl2  with  a 
solution  of  boric  acid,  a  perfectly  clear  solution  is  obtained, 
and  one  that  remains  so  indefinitely. 

165.  Sacchari  Saturni gr.  vj 

Kali  Hydriodici gr.  viij 

Syr.  Violarum  3  iv 

Aquae  Fontanae 5  j 

The  first  ingredient  is  sugar  of  lead,  or  lead  acetate;  the 
second,  potassium  iodide;  the  third,  syrup  of  violets  (a  syrup 
well  known  in  Europe  and  prepared  from  the  fresh  flowers  of 
viola  odorata,  our  "sweet-blue"  violet)  ;  and  the  fourth, 
spring  water.  It  does  not  require  much  knowledge  of  chem- 
istry to  be  aware  of  the  fact  that  the  first  two  ingredients 
are  incompatible.  Lead  iodide  precipitates.  The  reaction 
is  as  follows : 

Pb(C2Hs02)2  +  2KI  =  PbL  +  2KC2H30*. 

"When  the  potassium  iodide  is  greatly  in  excess  over  the 
lead  acetate,  the  precipitate  will  redissolve,  as  lead  iodide  is 
soluble  in  a  concentrated  solution  of  potassium  iodide  form- 
ing a  double  iodide  of  potassium  and  lead. 

166.  lodoformi  3  j 

01.  Olivae I  ij 

Aquae  IL02 %  ij 

Pulv.  Acaciae q.s. 

This  prescription  is  incompatible.  The  iodoform  being 
dissolved  in  the  oil,  the  peroxide  reacts  on  it  with  the  evolu- 
tion of  iodine.  Impurities  in  the  fixed  oil  will  also  sometimes 


PRESCRIPTION  INCOMPATIBILITIES          103 

cause  the  liberation  of  the  iodine.     (See  also  prescriptions 
152  and  153.) 

167.  Zinci  Sulphatis gr.  xviij 

Bism.  Subnitr §  ss 

Aq.  Hydrogenii  Dioxidi %  iij 

Aquae   I  iij 

I  have  tested  the  action  of  ZnS04  and  BiON03  on  the  hy- 
drogen dioxide,  separately  and  in  combination,  but  found  no 
decomposition ;  consequently,  this  prescription  may  be  con- 
sidered compatible. 

168.  Liq.  Hydrogenii  Peroxidi 3  vj 

Bals.  Peruvian! 3  ij 

S. :     Apply  with  camel's-hair  brush. 

At  first  no  deterioration  in  the  strength  of  the  peroxide 
could  be  detected.  On  repeatedly  shaking  it,  as  is  always 
necessary  before  applying  it,  the  peroxide  will  become  weaker, 
but  then  H202,  even  if  shaken  by  itself,  without  any  for- 
eign substance,  will  become  partially  decomposed  into  water 
and  oxygen.  But  the  pharmacist  has  no  reason  for  not  dis- 
pensing the  above  prescription. 

169.  Liq.  Hydrogenii  Dioxidi  1 

Tr.  Arnicae  L aa  3  ij 

Ext.  Calendulae  Fid. 

This  prescription  was  presented  to  me  for  analysis.  After 
the  mixture  stood  for  some  days  I  tested  it  for  the  peroxide 
by  applying  some  to  a  pus  cavity,  and  by  the  potassium  chro- 
mate  and  ether  test,  and  found  no  appreciable  diminution  in 
strength. 

170.  Cupri  Sulphatis  3  j 

Sodii  Bicarbon 3  j 

Aquae    3  ij 

S.:     Apply  with  brush  to  ulcerated  surface. 
This  prescription  is  absolutely  incompatible,  and  the  drug- 
gist would  do  the  physician  a  kindness  by  leaving  out  the 


104         PRESCRIPTION  INCOMPATIBILITIES 

sodium  bicarbonate.  It  is  seen  at  once  that  what  the  physi- 
cian wants  is,  to  use  the  copper  sulphate  as  a  caustic  applica- 
tion. By  adding  the  sodium  bicarbonate  he  completely  de- 
stroys the  caustic  effect,  as  the  copper  is  precipitated  as  cop- 
per carbonate,  which  is  insoluble  and  non-caustic.  By  mix- 
ing the  ingredients  and  at  once  corking  the  bottle,  there  is 
also  danger  of  explosion,  as  a  considerable  amount  of  CO2 
is  evolved.  The  following  equation  will  show  what  reaction 
takes  place: 

CuSO,  +  2NaHCO.  =  CuCOs  +  Na2SO<  +  CO*  +  ILO. 

The  right  course  to  pursue  is  to  inform  the  physician  and 
get  his  consent  to  omit  the  sodium  bicarbonate. 

COPPER  SULPHATE  Is  INCOMPATIBLE  WITH  SODIUM  BICAR- 
BONATE. 

171.  Tr.  Ferri  Chlor 3  ij 

Morph.  Sulph gr.  iij 

Glycerin!   3  ss 

Aquae q.s.  ad     3  nJ 

This  is  a  well-known  incompatibility.  Morphine  with  fer- 
ric salts  strikes  a  bluish-green  color ;  in  fact,  this  is  a  test  for 
morphine.  The  formation  of  the  color  is  prevented  by  the 
presence  of  free  acid,  but  it  is  rare  that  tincture  of  iron  con- 
tains so  much  free  acid  as  to  prevent  the  reaction.  In  this 
case  it  is  best  to  inform  the  physician  of  the  facts,  and  let 
him  act  as  he  sees  fit. 

MORPHINE  Is  INCOMPATIBLE  WITH  FERRIC  SALTS. 

172.  Hydrarg.  lodidi.  Flavi gr.  xxiv 

Potass.  lodidi 3  iij 

Syr.  Sarsapar.  Comp 3  ij 

Aquae   ^  j 

S. :    3  j  4  times  a  day. 

This  is  an  incompatible  and  extremely  dangerous  prescrip- 
tion ;  the  more  dangerous  because  if  the  syrup  of  sarsaparilla 
be  added  at  once  the  druggist  may  notice  no  change  in  the 


PRESCRIPTION  INCOMPATIBILITIES          105 

physical  appearance  and  dispense  it  without  hesitation.  Mer- 
curous  iodide,  in  the  presence  of  potassium  iodide  or  any 
soluble  iodide,  becomes  at  once  decomposed  into  mercuric 
iodide  and  metallic  mercury.  For  practicaj  purposes  it  is 
sufficiently  accurate  to  remember  that  one  part  of  mercurous 
iodide  will  form  about  two-thirds  of  one  part  of  mercuric 
iodide.  The  equation  and  the  calculation  are  as  follows  : 


654  =  200  +  454 

That  is  to  say,  654  parts,  when  decomposed,  will  form 
454  parts  of  mercuric  iodide;  reduce  those  figures  (it  cannot 
be  done  exactly)  and  two-thirds  will  be  the  approximate 
answer.  In  the  above  prescription  there  is  1  grain  per  dose 
of  the  mercurous  iodide  ;  this  would  give  %  grain  of  mer- 
curic iodide  per  dose,  which  dose  might  produce  distinctly 
toxic  effects,  especially  if  repeated  four  times  a  day.  There 
is  also  in  that  prescription  about  8  grains  of  finely  divided 
metallic  mercury,  but  no  danger  need  be  apprehended  from 
this  source,  as  metallic  mercury  may  be  taken  in  quite  large 
doses.  The  pharmacist  should  refuse  to  dispense  this  pre- 
scription and  communicate  with  the  physician. 

MERCUROUS  IODIDE  FORMS  A  DANGEROUS  INCOMPATIBILITY 
WITH  POTASSIUM  IODIDE,  OR  ANY  OTHER  SOLUBLE  IODIDE. 

173.     Hydrarg.  lodidi  Flavi  ......................  0.01 

Potass.  lodidi  .............................  0.075 

M.  et  ft.  pil.  No.  1.    D.  Tal.  Dos.  No.  xxiv. 
S.:     One  pill  three  times  a  day. 

This  and  the  previous  prescription  will  illustrate  what 
the  author  has  been  trying  to  impress  many  times,  namely, 
that  "  incompatible"  and  "non-dispensable"  are  not  synony- 
mous terms.  A  druggist  received  the  above  prescription, 
and  knowing  that  the  two  ingredients  were  incompatible,  he 
sent  to  the  physician,  stating  the  fact.  The  latter  said  he 
wanted  to  have  the  prescription  put  up  just  as  written. 
The  druggist  still  hesitated,  basing  himself  on  the  statement 


106          PRESCRIPTION  INCOMPATIBILITIES 

of  the  U.  S.  Dispensatory,  which  says:  "It  (yellow  mercur- 
ous  iodide)  should  never  be  given  at  the  same  time  with 
potassium  iodide,  which  converts  it  immediately  into  mer- 
curic iodide  and  metallic  mercury."  He  consulted  me  as 
"final  authority,"  and  I  advised  him  to  dispense  the  pre- 
scription. The  chief  difference  between  the  two  prescrip- 
tions is  in  the  dose.  This  one  contains  only  1-6  grain  of 
mercurous  iodide,  which,  even  assuming  that  it  becomes  en- 
tirely decomposed,  will  yield  only  1-9  grain  of  mercuric 
iodide,  and  that  is  a  perfectly  safe  dose.  Thus,  the  question 
"to  dispense  or  not  dispense,"  frequently  turns  on  the  size 
of  the  dose.  Another  difference  between  this  and  the  pre- 
ceding prescription  is  that  many  druggists  will  in  this  case 
use  the  dry  potassium  iodide,  mix  it  with  some  inert  powder, 
as  althea  or  licorice,  and  then  make  a  pill  mass  with  some 
mucilage  of  acacia  or  glycerite  of  starch.  In  this  condition 
only  a  portion  of  the  mercurous  iodide  will  be  decomposed. 

174.  Spts.  Ammon.  Arom. 

Syr.  Gallae  aa  J  i 

Aquae  Cinnamomi   t 3  ij 

This  combination  forms  an  unsightly  precipitate,  due  to 
the  combination  of  the  tannic  and  gallic  acids  in  the  nutgall 
syrup  with  the  ammonium  carbonate  in  the  spirit.  Syrupus 
gallae,  or  syrupus  gallae  aromaticus,  was  a  great  favorite 
with  the  physicians  of  two  generations  ago,  and  a  very  pow- 
erful and  effective  syrup  it  was.  Now  it  is  almost  completely 
forgotten,  but  is  still  occasionally  prescribed  by  those  who 
cling  to  the  old  traditions. 

175.  Hydrarg.  Chlor.  Mitis gr.  xvj 

Amm.  Chloridi  gr.  xij 

Sacch.  Lactis  gr.  xx 

Div.  into  pulv.  No.  iv. 

The  result  in  this  prescription  will  depend  a  good  deal  on 
the  quality  of  the  ammonium  chloride.  If  a  salt  answering 
the  Pharmacopeial  requirements  be  used,  there  need  be  no 


PRESCRIPTION  INCOMPATIBILITIES          107 

fear  of  any  incompatibility.  The  writer  believes  that  no 
mercuric  chloride  is  formed.  If  any  is  formed,  it  is  so  infini- 
tesimal in  amount  as  to  be  disregardable  altogether.  But  if 
the  commercial  impure  muriate  be  used,  the  prescription  may 
be  considered  incompatible.  In  several  triturations  which 
the  writer  made  he  could  discover  decomposition  after  several 
hours ;  the  powders  contained  mercurous  oxide,  metallic  mer- 
cury, mercuric  chloride,  and  probably  also  dimercur-ammo- 
nium  chloride.  In  some  cases  the  powder  became  of  a  grayish 
color  after  two  minutes'  trituration. 

176.  Hydrarg.  Chlor.  Mit 3  j 

Ammon.  Carbon 5  j 

Sacch.  Albi  5  ss 

Div.  into  pulv.  No.  xij. 

This  prescription  is  positively  incompatible.  When  ammo- 
nium carbonate  is  rubbed  with  calomel,  a  gray  color  develops 
at  once.  This  is  due  to  the  formation  of  the  black  ammo- 
nium-mercurous  chloride,  or  dimercur-ammonium  chloride, 
NH2Hg2Cl.  This  compound  may  not  be  actively  poisonous, 
but  the  chemical  composition  of  the  calomel  and  the  external 
appearance  of  the  powder  are  so  changed  that  the  prescrip- 
tion should  under  no  circumstances  be  dispensed.  The  ammo- 
nium carbonate  is  to  be  left  out.  The  writer  vividly  remem- 
bers when  he  received  this  prescription  the  first  time  and 
made  it  up.  It  was  in  the  good  old  junior  days,  when  every 
day  brought  some  new  facts,  some  new  knowledge,  some  new 
discovery.  "When  he  saw  the  powder  turning  black  he  called 
the  employer's  attention  to  it.  The  latter,  a  European  Master 
of  Pharmacy  (Magister  Pharmaciae),  explained  that  those 
two  drugs  were  incompatible  and  recommended  to  leave  out 
the  ammonium  salt,  which  he  did,  and  notified  the  physician 
to  that  effect.  The  next  morning  brought  a  reply  from  that 
physician  full  of  thanks  and  apologies. 

CALOMEL  Is  POSITIVELY  INCOMPATIBLE  WITH  AMMO- 
NIUM CARBONATE. 


108          PRESCRIPTION  INCOMPATIBILITIES 

177.  Hydrarg.  Chlor.  Hit 3  j 

Ac.  Hydrochlor.  Dil 3  ss 

Syr.  Rhei  Arom 3  ss 

Aquae    ad  3  ij 

A  physician  who  will  prescribe  a  heavy  powder  like  calo- 
mel in  a  shake  mixture  is  a  very  poor  prescriber.  Perhaps 
he  is  not  aware  of  the  fact  that  calomel  is  insoluble.  In 
this  prescription  the  patient  may  get  in  one  dose  anywhere 
from  2  to  10  grains  of  calomel,  and  the  physician  can  cer- 
tainly not  expect  uniform  or  satisfactory  results.  This  is 
the  only  thing  wrong  with  this  prescription.  The  fear  of 
there  being  formed  corrosive  sublimate  from  the  action  of 
the  hydrochloric  acid  on  the  calomel  is  groundless.  The 
writer  failed  to  discover  any  with  the  most  delicate  tests. 

CALOMEL  Is  NOT  INCOMPATIBLE  WITH  HYDROCHLORIC  ACID. 

178.  Hydrarg.  Chlor.  Mit 3  ij 

Syr.  Rhei  -,  ... 

Aquae        } aa^SS 

S. :    3  i  twice  a  week  on  going  to  bed. 

This  prescription  is  incompatible,  though  it  may  not  ap- 
pear so  at  first  glance.  Syrup  of  rhubarb  contains  potassium 
carbonate;  the  latter  will  convert  a  portion  of  the  calomel 
into  black  mercurous  oxide,  and  gradually  there  may  form 
some  mercuric  oxide  and  metallic  mercury. 

179.  Tr.  Ferri  Chlor. 
Potass.  Brom. 

Sodii  Brom aa  10.0 

Glycerini   15.0 

Aquae q.s.  ad  60.0 

The  bromides,  like  the  iodides,  are  incompatible  with  ferric 
chloride.  The  latter  decomposes  them  with  the  liberation  of 
bromine  or  iodine,  as  the  case  may  be.  The  equation  is  as 
follows : 

2KBr  +  2FeCl.  =  2KC1  +  2FeCl,  +  Br* 


PRESCRIPTION  INCOMPATIBILITIES          109 

As  is  seen,  the  ferric  chloride  is  converted  into  ferrous 
chloride. 

As  free  bromine  is  irritating  to  the  stomach,  the  prescrip- 
tion should  hardly  be  dispensed  without  informing  the  physi- 
cian of  the  facts. 

180.  Camphorae  Monobrom gr.  iij 

Chlorali  Hydrati gr.  v 

Lupulini    gr.  ij 

M.  et  ft.  caps.  No.  1. 

When  monobromated  camphor  and  hydrated  chloral  are 
triturated  together,  a  soft  moist  mass  is  formed,  which  on 
further  trituration  becomes  semi-liquid  or  liquid.  Neverthe- 
less, the  prescription  may  be  dispensed,  as  follows :  Rub  the 
monobromated  camphor  with  some  absorbent  powder,  such 
as  starch  or  althea;  do  the  same  thing  with  the  chloral  and 
lupulin;  then  mix  the  two  powders  gently  with  a  spatula, 
without  trituration,  and  fill  into  capsules.  Should  the  cap- 
sules come  out  too  large,  double  the  number  may  be  filled, 
and  the  patient  ordered  to  take  two  capsules  instead  of  one. 
The  capsules  should  be  kept  in  a  cool  and  dry  place. 

181.  Magnes.  Calcinatae 5  ij 

Pancreatini    3  ij 

Bism.  Subnitratis 3  iss 

M.  ft.  pulvis.  Detur  at  scatulam. 

S. :     Take  as  much  as  can  be  placed  on  a  twenty-five  cent 

piece  3  times  a  day  after  meals. 

Druggists  rarely  affix  a  "shake  well"  label  to  boxes  con- 
taining bulk  powders.  Nevertheless,  it  is  occasionally  as  nec- 
essary as  with  some  liquid  mixtures.  We  are  apt  to  forget 
that  powders  possess  different  specific  gravities,  and  if  such 
powders  be  mixed  and  not  shaken  frequently  they  will  sep- 
arate and  form  different  layers,  almost  in  the  same  manner 
as  two  or  more  immiscible  liquids  of  different  specific  gravi- 
ties do.  The  writer  has  made  experiments  on  the  subject, 
and  found  that  if  the  powders  be  of  different  colors  the  dif- 
ferent layers  can  be  beautifully  demonstrated.  In  this  pre- 


110          PRESCRIPTION  INCOMPATIBILITIES 

scription  almost  the  entire  bismuth  subnitrate  will  be  found 
on  the  bottom,  while  the  magnesia  will  be  on  top.  The  only 
way  to  obviate  the  difficulty  is  to  direct  the  patient  to  shake 
the  box  well  before  taking  the  powder.  This  method  of  pre- 
scribing, while  very  common  with  German  physicians,  is  not 
to  be  commended.  Its  only  recommendation  is  cheapness. 

182.  Liq.  Hydrogenii  Dioxidi %  j 

Acidi  Carbol gr.  xv 

Tr.  Ferri  Chlor 3  ij 

Glycerin!  3  i 

Aquae q.s.  ad  3  iv 

S. :  3  j  four  times  a  day  in  a  little  water. 
This  is  one  of  the  best  possible  specimens  of  incompatibil- 
ity. On  mixing  the  first  three  ingredients  a  violent  reaction 
takes  place  at  once;  intense  heat  is  generated,  a  very  strong 
empyreumatic  odor  becomes  noticeable,  and  the  mixture 
froths  and  turns  perfectly  black.  Of  course,  nobody  would 
dispense  such  a  mixture.  The  exact  reaction  is  too  compli- 
cated to  be  given  here;  one  thing  may  be  stated;  the  car- 
bolic acid  reaches  the  highest  point  of  oxidation,  and  may  be 

said  to  be  completely  "burned  up." 

.   ,v 

183.  Potass.  Permang 3  ss  \ 

Acidi  Carbolic! 3s8  ^ 

Aquae  3  iv 

This  is  another  example  of  the  desire  to  get  too  much,  but 
of  getting  nothing  instead.  Both  ingredients  are  antiseptics, 
but  react  upon  each  other  with  the  following  result :  The  po- 
tassium permanganate  becomes  reduced,  while  the  phenol  is 
oxidized  to  oxalic  acid  and  carbon  dioxide.  The  following 
equation  shows  the  reaction: 

C.ILOH  +  12KMn04  =  2ILCzO«  + 
Phenol          Potass.  Oxalic 

Permang.  Ac. 

2CO,  +  ILO  +  6K2MnO*  +  6MnO, 
Carbon    Water  Potass.  Manganese 

Dioxide.  Manganate    Dioxide 


PRESCRIPTION  INCOMPATIBILITIES          111 

No  pharmacist  will  think  of  dispensing  this  mixture,  as  it 
is  too  nasty-looking;  if  the  quantity  of  potassium  perman- 
ganate is  larger,  a  solid  or  semi-solid  mass  is  obtained  on 
account  of  the  manganese  dioxide  which  precipitates.  (In 
this  prescription  the  quantity  of  phenol  is  excessive;  not 
more  than  2  drams  will  dissolve  in  4  fl.  ozs.  of  water.) 

184.     Potass.  Permang. 3  ss 

Ac.  Salicylic! 3  j 

Aquae   0  j 

S.:     Dip  a  cloth  and  apply  to  ulcer,  changing  every  half 

hour. 

A  black  mixture  is  obtained  at  once.  The  potassium  per- 
manganate becomes  reduced  to  potassium  manganate  and 
manganese  dioxide ;  while  the  salicylic  acid  is  decomposed  into 
formic  acid  and  carbon  dioxide.  The  reaction  may  be  ex- 
pressed as  follows: 

HCMLO,  +  10KMnO«  +  ILO  =  4HCHO,  + 
Salicyl.         Potass.  Water  Formic 

Acid  Permang.  Acid 

SCO,  +  5KiMnO«  +  5MnO, 

Carbon  Potass.          Mangan.  Dioxide. 

Dioxide  Manganate 

It  should  be  understood  that  all  statements  concerning  re- 
actions in  which  potassium  permanganate  is  one  of  the  fac- 
tors are  only  relatively  correct ;  because  the  reaction  depends 
to  a  great  extent  upon  the  quantity  of  the  permanganate 
present,  the  concentration  of  the  solution,  the  temperature 
employed,  etc.  For  instance,  there  can  be  no  doubt  that  if 
sufficient  permanganate  be  present,  even  the  formic  acid  will 
undergo  further  oxidation  until  it  is  split  up  into  carbon 
dioxide  and  water ;  thus :  HCHO2  -f  O  =  CO2  -f  H20. 

The  patient  who  had  an  ulcer  of  many  years '  standing  said 
that  he  had  derived  more  benefit  from  this  mixture  than  from 
anything  he  had  ever  used.  His  ulcer  was  eventually  healed. 
Was  it  time  for  it  to  get  healed,  was  it  the  formic  acid,  was  it 
the  balance  of  the  undecomposed  salicylic  acid — who  will 
say? 


112          PRESCRIPTION  INCOMPATIBILITIES 

185.  Codeinae gr.  iv 

Ammon.  Chlor 3  j 

Syr.  Ipecac 3  ij 

Syr.  Tolu B  i 

Aquae q.s.  ad      %  ij 

S. :     Teaspoonful  every  3  hours. 

This  prescription  cannot  be  considered  incompatible.  It  is 
true  that  codeine,  having  a  strong  alkaline  reaction,  liberates 
some  ammonia  gas  from  the  ammonium  chloride  (the  same  as 
potassium  or  sodium  hydroxide  does),  but  the  quantity  is 
so  small  that  it  may  be  disregarded.  It  is  best  not  to  bring 
the  codeine  and  the  ammonium  chloride  together  at  once, 
but  to  dissolve  each  separately  and  then  mix  the  solutions. 

186.  01.  Tiglii min.  viij 

01.  Ricini 3  i 

Glycerin!   3  iij 

S.:     Teaspoonful  every  hour  until  bowels  have  operated 

freely. 

Physicians  and  many  druggists  regard  glycerin  in  the 
nature  of  a  fat  or  fixed  oil,  and  think  that  both  fixed  and 
volatile  oils  are  freely  miscible  with  it.  They  are  quite  sur- 
prised when  they  find  out  that  the  contrary  is  the  case.  The 
people  attending  the  patient  must  be  directed  to  shake  the 
bottle  very  thoroughly  each  time  before  administering  the 
medicine.  Otherwise  the  mixture  of  the  two  oils  will  be 
on  top  of  the  glycerin,  and  the  patient  may  get  all  or  half 
of  the  croton  oil  at  one  dose.  The  dose  of  the  croton  oil — 
2  drops  every  half  hour — seems  rather  large,  but  as  it  was 
for  a  case  of  lead  colic,  where  a  quick  operation  was  abso- 
lutely necessary,  it  was  probably  all  right. 

187.  Ac.  Salicylic!  3  ss 

Aquae  Calcis  3  ^ij 

S.:    Apply  externally. 

Glancing  casually  at  the  prescription  we  might  think  that 
the  greater  part  of  the  salicylic  acid  will  remain  undissolved ; 


/      PRESCRIPTION  INCOMPATIBILITIES  113 

the  solubility  of  salicylic  acid  in  water  being  1  in  460,  only 
about  1  grain  dissolves  in  one  ounce  of  water,  and  it  would 
require  about  28  ounces  of  water  to  dissolve  the  entire  quan- 
tity of  salicylic  acid  prescribed.  But  in  this  case  we  get  a 
perfectly  clear  solution,  the  reason  being  that  a  chemical 
reaction  takes  place,  the  salicylic  acid  combining  with  the 
calcium  hydroxide  to  form  calcium  salicylate.  Of  course  the 
lime  water  must  contain  some  lime.  Some  samples  which 
we  had  occasion  to  analyze  were  found  to  be  absolutely  free 
from  lime. 

188.  Ac.  Salicylic!  gr.  x 

Hydrarg.  Chlor.  Mitis gr.  x 

Liq.  Calcis  %  ij 

S. :     Apply  externally  as  directed. 

This  prescription  has  caused  considerable  trouble  in  one 
drug-store.  The  first  time  the  proprietor  made  it  up,  and  he 
dispensed  it  as  a  mixture  with  a  white  sediment;  on  being 
renewed,  the  clerk  dispensed  it,  and  it  was  a  black  mixture. 
The  patient  brought  it  back  and  a  lot  of  explanations  had 
to  follow.  The  first  time  it  was  made  up  by  adding  the 
salicylic  acid  to  the  lime  water;  that  neutralized  the  calcium 
hydrate,  forming  calcium  salicylate  [Ca(OH)2-f-  2HC7H5 
O3  =  Ca(C7H503)2-f  2H20]  ;  on  then  adding  the  calomel, 
no  further  reaction  took  place,  and  the  result  was  a  white 
mixture.  The  second  time  the  calomel  was  added  directly 
to  the  lime  water;  that  produced  the  black  oxide  of  mercury 
[Ca(OH)2  +  2HgCl  =  Hg20  +  CaCl2  +  H20],  which  re- 
mained unchanged  on  the  subsequent  addition  of  salicylic 
acid. 

189.  Tr.  Nuc.  Vom 3  iss 

Tr.  Ferri  Chlor 3  iv 

Potassii  Hypophosph 3  ii 

Sodii  Hypophosph. -i  aa  3  ii' 

Calcii  Hypophosph.J 


114          PRESCRIPTION  INCOMPATIBILITIES 

Essence  Peps.  (Fairchild) %  j 

Elixir  Peptenzyme 3  J 

Glycerini   3  ss 

Aquae q.s.  ad  §  vj 

S. :     3  i  ter  in  die,  post  cibum. 

The  correspondent  sending  this  prescription  asked  what 
the  matter  with  it  was,  and  whether  it  should  have  been  dis- 
pensed as  written.  This  is  a  very  nice  prescription,  theoret- 
ically. The  doctor  seeks  to  combine  the  tonic  effect  of  mix 
vomica,  the  hematinic  actions  of  the  iron,  the  "  neuro-nutri- 
ent"  effects  of  the  three  hypophosphites,  and  the  digestive 
effects  of  pepsin  and  peptenzyme.  But  the  mixture  cannot 
be  dispensed;  not  in  a  presentable  form,  at  any  rate.  The 
trouble  is  between  the  hypophosphites  and  the  ferric  chlo- 
rides; the  insoluble  ferric  hypophosphite  forms  at  once  and 
precipitates.  If  the  solutions  are  concentrated  enough,  a 
gelatinous,  almost  solid  mass  is  produced. 

Can  this  precipitation  be  prevented?  Well,  by  using  a 
sufficient  amount  of  hypophosphorous  acid  or  potassium  (or 
sodium)  citrate,  it  can ;  but  this  prescription  already  con- 
tains so  many  ingredients  that  it  is  hardly  justifiable  to  add 
any  more.  The  tincture  of  iron  might  be  left  out  altogether. 
However,  there  is  a  better  way,  which  will  certainly  appeal 
to  the  physician;  and  that  is  to  substitute  another  ferric  com- 
pound for  the  ferric  chloride.  The  most  eligible  salt  in  this 
case  is  the  ammonio-ferric  citrate  (Ferri  et  Ammonii  citras, 
U.  S.  P.).  No  precipitation  takes  place  between  this  ferric 
salt  and  the  hypophosphites.  As  to  the  amount  of  ammonio- 
ferric  citrate  which  corresponds  to  the  quantity  of  tincture 
ordered,  a  slight  calculation  will  give  the  result.  Tincture 
of  iron  contains  an  amount  of  FeCl3,  corresponding  to  4.7 
per  cent,  of  metallic  iron;  the  citrate  of  iron  contains  16 
per  cent,  of  Fe.  Seventy-one  grains  of  the  latter  will,  there- 
fore, be  the  equivalent  in  metallic  iron  of  half  an  ounce  of 
the  former. 


PRESCRIPTION  INCOMPATIBILITIES          115 

190.  Tr.  Ferri  Chlor  ............................  3  vi 

Syr.  Hypophosphitum  ....................  ad   3  iij 

S.:    3  i  t.i.d. 

An  almost  solid  mass  results,  or  a  thick  liquid  with  an 
unsightly  precipitate.  The  cause  is  the  same  as  in  the  pre- 
vious prescription;  the  formation  of  ferric  hypophosphite, 
Fe(PH2O2)3.  Potassium  citrate  dissolved  in  the  smallest 
amount  of  water  possible,  or  simply  dissolved  in  the  syrup, 
should  be  used  to  prevent  the  formation  of  the  precipitate 
or  to  dissolve  it  after  it  has  formed.  A  perfectly  clear  solu- 
tion of  a  greenish  color  is  the  .result. 

191.  Tr.  Ferri  Chlor  .............................  3  ii 

Syr.  Hypophosphitum  .............  *  .........  3  J 

Aquae    ..................................  ad  3  ij 

If  the  tincture  is  first  mixed  with  the  water  and  the  syrup 
then  added,  no  precipitation  will  take  place.  Should  the  first 
two  ingredients  have  been  mixed  with  the  formation  of  a  pre- 
cipitate, the  water  will  redissolve  it.  Ferric  hypophosphite 
is  slightly  soluble  in  water,  especially  in  the  presence  of  hypo- 
phosphorous  acid,  a  trace  of  which  is  present  in  the  syrup. 

192.  Tr.  lodi  ...................................  3  i 

Liq.  Hydrogenii  Dioxidi  .....................  §  ij 

S.:    For  external  use. 

This  prescription  is  incompatible  and  should  not  be  dis- 
pensed. 

In  the  above  there  soon  commences  quite  an  active  reac- 
tion between  the  iodine  and  the  peroxide  ;  the  iodine  is  con- 
verted into  hypo-iodous  acid,  according  to  the  following  reac- 
tion: 


This,  as  will  be  seen,  is  similar  to  the  reaction  which  takes 
place  on  mixing  chlorine  water  with  solution  of  hydrogen 
peroxide.  But  here  the  similarity  ceases.  While  the  hypo- 
chlorous  acid  on  coming  into  contact  with  another  molecule  of 


116          PRESCRIPTION  INCOMPATIBILITIES 

H202  becomes  reduced  to  hydrochloric  acid  (with  liberation 
of  oxygen  :  HC10  +  H202  =  HC1  -f  H2O  +  O2)  the  oppo- 
site reaction  takes  place  with  the  hypo-iodous  acid;  instead 
of  becoming  reduced  to  hydriodic  acid,  it  becomes  oxidized  to 
iodic  acid.  Reaction  as  follows  : 
HIO  +  2ILO,  =  HIO*  +  2ILO. 

The  writer  has  established  these  facts  beyond  doubt;  care- 
ful chemical  analysis  proved  the  absence  of  hydriodic  acid, 
while  showing  the  presence  of  iodic  acid  in  abundance. 

193.    Potass.  Permang  ..............  .............  3  ss 

Ferri  Sulphatis  ...........................  3  j 

Ac.  Sulph.  Dil  .............................  3  ij 

Magnes.  Sulphat  ..........................  %  ij 

Syr.  Zingiberis  ............................  §  i  j 

Aquae  .............................  q.s.  ad    3  viij 

This  combination  minus  the  potassium  permanganate  is 
the  favorite  prescription  of  a  very  well-known  gynecologist 
of  this  city  in  many  female  ailments.  The  above  was  writ- 
ten by  a  young  practitioner,  who  thought  he  would  improve 
it  by  adding  the  salt  which  is  reputed  to  be  so  useful  in 
amenorrhea.  The  permanganate  is  decomposed,  while  the 
ferrous  salt  is  converted  into  the  irritant  and  astringent  fer- 
ric sulphate  ;  thus  : 

2KMn(X  +  lOFeSO*  +  SILSO*  =  2MnSC>4  +  5Fez(SCM3 
Potass.          Ferrous          Sulphuric  Manganous     Ferric 
Permang.      Sulphate        Acid  Sulphate        Sulphate 


Potass.          Water 
Sulphate 

194     Ammonii  Benzoatis  .........................  3  ij 

Sodii  Benzoatis  ............................  3  vi 

Tr.  Ferri  Chloridi  ..........................  3  iv 

Tr.  Gentianae  ..............................  3  igs 

Syr.  Aurantii  Fl  ............................  3  i 

Aquae    .................................  ad  $  vi 

In  this  prescription  a  voluminous  precipitate  filling  the 


PRESCRIPTION  INCOMPATIBILITIES          lit 

entire  bottle  is  formed.  All  soluble  benzoates  are  incom- 
patible with  ferric  salts,  insoluble  ferric  benzoate  being 
formed.  The  precipitate  is  described  as  flesh-colored,  but  I 
do  not  think  that  that  expression  aptly  describes  it.  It  is 
rather  a  light-brown  or  buff  color.  If  the  two  tinctures  are 
mixed  first  a  dark  mixture  will  result;  on  account  of  the 
tannic  acid  in  the  gentian  producing  with  the  iron  the  black 
ferric  tannate. 

195.  Kali  lodati   3  vi 

Aquae  Regiae 3  ij 

Aquae  Fontanae 3  "J 

S. :     Cochlear  parvum  post  cibum. 

This  mixture  soon  turns  dark  brown.  Nitrohydrochloric 
acid  contains  free  chlorine,  which  decomposes  the  potassium 
iodide,  with  the  liberation  of  iodine.  If  taken  by  the  patient, 
this  mixture  would  be  liable  to  prove  extremely  irritating. 

196.  Resorcin    gr.  iij 

Antipyrine  gr.  viij 

Phenacetin   gr.  ij 

M.f .  pulv.  No.  1.  Dent.  Tal.  Dos.  iv.  S. :  One  every  hour. 
Resorcin  is  incompatible  with  antipyrine;  when  prescribed 
in  powder  form,  they  liquefy,  especially  in  damp  weather. 
There  is  no  way  of  preventing  it,  except  by  placing  the  re- 
sorcin  on  top  of  the  antipyrine  and  phenacetin,  without  any 
trituration;  or  by  putting  the  resorcin  in  separate  powders. 

197.  Tr.  Ferri  Chloridi 10.0 

Resorcinol 5.0 

Glycerini 20.0 

Aquae 100.0 

Resorcin  is  very  similar  in  most  of  its  reactions  to  phenol. 
Carbolic  acid  is  a  monatomic  phenol,  while  resorcin  is  a  dia- 
tomic phenol,  that  is,  one  hydrogen  in  the  carbolic  acid  is 
replaced  by  a  hydroxide.  The  deep  violet-blue  color  of  this 
mixture  is  due  to  the  reaction  between  the  ferric  chloride  and 
the  resorcin. 


118          PEESCRIPTION  INCOMPATIBILITIES 

198.  01.  Terebinthinae  3  iij 

Morph.  Acetatis gr.  i 

S.:     Every  six  hours  fifteen  drops. 

This  is  a  somewhat  peculiar  prescription.  On  adding  the 
morphine  to  the  oil  it  will  be  found  that  it  sticks  to  the  sides 
and  bottom  of  the  bottle,  and  if  dispensed  in  this  way  the 
patient  would  get  no  morphine.  The  way  one  druggist  dis- 
pensed it  was  by  adding  to  the  oil  an  approximately  equiva- 
lent quantity  of  oleate  of  morphine.  A  more  eligible  method 
would  be  the  following:  Dissolve  the  morphine  in  a  little 
water,  add  a  few  drops  of  olive  oil  and  a  few  grains  of  pow- 
dered acacia,  rub  until  emulsified;  and  incorporate  the  oil 
of  turpentine.  Direct  the  patient  to  shake  the  bottle  well 
before  using. 

199.  Tr.  Ferri  Chloridi 3  ij 

Tr.  Valerian.  Ammon 3  vi 

30  drops  three  times  a  day. 

The  aromatic  spirit  of  ammonia  employed  in  making  the 
ammoniated  tincture  will  precipitate  the  iron  as  ferric  hy- 
droxide. It  would  be  practically  impossible  to  take  the  med- 
icine by  drops  or  even  by  teaspoon,  as  the  precipitate  is  very 
bulky  and  gelatinous.  There  is  no  way  out  of  the  difficulty. 

200.  Hepar  Sulphuris 5  i 

Liq.  Hydrogenii  Peroxidi   %  ij 

Aquae  Rosae 3  ij 

S. :    Lotion.    Apply  at  night  on  gauze. 

I  doubt  whether  this  lotion,  which  is  expected  to  beautify 
the  complexion,  has  any  virtue  in  it  whatsoever.  The  liver 
of  sulphur — or  potassa  sulphurata — is,  as  is  well  known,  not  a 
definite  compound,  but  a  mixture  of  all  or  of  several  of  the 
following  compounds:  Potassium  monosulphide,  K2S;  potas- 
sium trisulphide,  K2S3 ;  potassium  pentasulphide,  K2S5 ;  potas- 
sium thiosulphate  (wrongly  called  hyposulphite),  K,S203; 
and  potassium  sulphate,  K2S04.  When  dissolved  in  water, 
liver  of  sulphur  yields  an  orange-yellow  solution ;  on  adding 


PRESCRIPTION  INCOMPATIBILITIES          119 

peroxide  of  hydrogen,  the  solution  becomes  milky  white.  All 
the  various  sulphides  become  oxidized  to  sulphates;  the  per- 
oxide, of  course,  becomes  reduced  to  hydrogen  monoxide,  i.  e., 
water.  The  milky  turbidity  is  due  to  the  sulphur  which  pre- 
cipitates from  the  thiosulphate. 

201.  Liver  of  Sulphur 10  grains 

Corrosive  Sublimate 4  grains 

Rose  water 4  fl.  oz. 

This  is  a  newspaper  prescription,  given  by  the  newspaper 
doctor  in  reply  to  a  request  for  a  lotion  to  remove  freckles. 
The  preparation  is  worthless.  On  account  of  the  various 
compounds  of  which  sulphurated  potassa  consists,  a  number 
of  reactions  will  take  place.  The  chief  reaction  results  in  the 
formation  of  the  black  mercuric  sulphide,  which  gives  a  black, 
dirty  appearance  to  the  mixture. 

202.  Tr.  Ferri  Chloridi 3  ij 

Tr.  Digitalis 3  j 

Glycerin!   3  iv 

Aquae q.s.  ad  J  iij 

On  mixing  the  tincture  of  iron  with  the  tincture  of  digi- 
talis a  dark  mixture  results.  This  is  due  to  the  tannic  acid 
in  the  digitalis  combining  with  the  iron  to  form  iron  tannate. 
Otherwise  the  prescription  is  all  right.  It  is  best  to  mix  the 
tincture  of  iron  with  the  other  ingredients,  and  add  the  tinc- 
ture of  digitalis  last. 

203.  Bismuthi  Subnitr 3  j 

Argenti  Nitratis gr.  iij 

Sod.  Bicarbon 3  vj 

Ext.  Opii  gr-  iv 

Sacchari q.s.  ad      3  iy 

M.  et  ft.  pulvis.  Sig:  3  j  t.i.d. 

On  standing,  this  powder  becomes  blackened  on  account 
of  the  reduction  of  the  silver  nitrate  to  silver  oxide  and  then 
to  metallic  silver.  The  reduction  is  caused  by  the  organic 
ingredients  in  the  prescription.  After  a  while  there  is  no 


120          PRESCRIPTION  INCOMPATIBILITIES 

silver  nitrate  left.  If  the  physician  insists  on  having  the 
prescription  put  up  just  as  written,  he  can  have  it.  The 
silver  nitrate  should  be  first  reduced  to  a  fine  powder,  then 
carefully  and  slowly  mixed  with  the  bismuth  subnitrate  and 
the  sodium  bicarbonate;  the  extract  of  opium  is  to  be  thor- 
oughly incorporated  with  the  sugar,  and  the  powders  mixed. 
This  way  of  compounding  will  give  the  best  results.  The 
physician  is  mistaken  if  he  expects  the  patient  to  get  a  uni- 
form dose  of  silver  nitrate  and  extract  of  opium  in  each  tea- 
spoonful  of  powder. 

204.    Bism.  Subnitr 3  J 

Argenti  Nitr gr.  vj 

Sod.  Bicarbon 3  vj 

Ext.  Opii  Aquos gr.  iv 

Syr.  Aur.  Cort B  J 

Aquae q.s.  ad      3  iv 

The  ingredients  in  this  prescription  are  practically  the 
same  as  in  the  previous  one,  but  the  reactions  are  different. 
This  is  due  to  the  fact  that  the  mixture  is  a  liquid.  The 
silver  nitrate  has  here  three  incompatibilities ;  the  opium,  the 
syrup,  and  the  sodium  bicarbonate.  When  a  solution  of  so- 
dium bicarbonate  is  added  to  a  solution  of  silver  nitrate  the 
latter  is  at  once  completely  precipitated  as  the  white  silver 
carbonate.  In  time  the  latter  is  reduced,  as  all  silver  salts 
are.  There  is  another  possible  source  of  trouble  in  this  pre- 
scription ;  it  is  between  the  bismuth  subnitrate  and  the  so- 
dium bicarbonate.  When  standing  in  a  warm  place,  this 
mixture  may  explode,  due  to  the  liberation  of  carbon  dioxide. 
This  gas  is  evolved  by  the  nitric  acid,  which  is  liberated  from 
the  subnitrate,  and  acts  on  the  sodium  bicarbonate.  The 
equations  are  as  follows: 

I.    2BiONOs  4-  2ILO  =  BiONOs  +  Bi(OH)3  +  HNO.. 
H.    NaHCo,  +  HNOa  =  NaNO*  +  CO*  +  ILO. 

In  this  prescription  only  about  2  drs.  of  the  sodium  bicar- 
bonate will  be  dissolved ;  4  drs.  remain  at  the  bottom  of  the 


PRESCRIPTION  INCOMPATIBILITIES          121 

bottle,  together  with  the  bismuth  subnitrate  and  silver  car- 
bonate. 

205.  Quinin.  Hydrochloridi 5  i 

Amm.  Carbonatis  3  i 

Syr.  Aurantii 3  ss 

Aquae  Menthae  Pip |  iij 

Why  physicians  will  prescribe  a  very  soluble  quinine  salt 
and  then  precipitate  it,  is  beyond  comprehension.  The  qui- 
nine hydrochloride  dissolves  easily  in  the  prescribed  quan- 
tity of  water;  but  the  ammonium  carbonate  (like  all  alkaline 
carbonates)  causes  a  precipitate  of  alkaloidal  quinine. 

206.  Camphorae gr.  xxiv 

Morphinae  Sulph gr.  vj 

Tr.  Capsici £  ss 

Aetheris 3  ss 

S.:  20  drops  every  V2  hour  until  attack  is  over. 
This  prescription  must  not  be  dispensed,  as  written,  under 
any  circumstances.  Only  a  small  fraction  of  a  grain  of  the 
morphine  will  dissolve;  the  rest,  about  5%  grn.,  will  re- 
main in  suspension.  As  the  medicine  is  to  be  dropped,  there 
is  no  possibility  of  adjusting  the  dose  rightly.  In  one  dose 
there  may  be  only  ys  grn.,  while  in  the  next  there  may  be  1 
or  2  grn.  As  these  doses  are  to  be  repeated  frequently,  there 
is  altogether  too  much  risk  in  dispensing  the  mixture.  The 
reason  why  the  morphine  sulphate  will  not  dissolve  is  because 
it  requires  about  700  parts  of  alcohol  for  solution,  while  in 
ether  it  is  practically  insoluble.  In  such  cases  it  is  usually 
possible  to  get  out  of  the  dilemma  by  employing  the  pure  alka- 
loid instead  of  the  salt.  Unfortunately,  this  is  not  the  case 
with  morphine,  for  alkaloidal  morphine  requires  300  parts 
of  alcohol  and  4,000  parts  of  ether  for  solution.  The  acetate 
and  the  hydrochloride  of  morphine  are  much  more  soluble  in 
alcohol  than  either  the  sulphate  or  the  alkaloid ;  but  they 
would  not  do  either,  as  the  most  that  would  dissolve  of  these 
drugs  in  the  quantity  of  the  menstruum  given  would  be 


122          PRESCRIPTION  INCOMPATIBILITIES 

from  3  to  3y2  grn.  This  is  the  way  the  writer  would  get 
over  the  difficulty:  Make  up  the  prescription  without  the 
morphine.  As  the  physician  evidently  intended  14  grn.  of 
morphine  per  dose  (in  the  physician's  mind  drop  is  always 
equivalent  to  minim  ;  6  grn.  divided  into  24  doses  make  y±  grn. 
per  dose),  inclose  24  tablet  triturates  of  !/4  grn.  each.  At  the 
same  time  send  a  note  to  the  physician  of  about  the  following 
contents  : 

''Dear  Doctor:  —  Morphine  sulphate  is  insoluble  in  tincture 
of  capsicum  and  in  ether  ;  I  therefore  left  it  out  and  send  24 
tablet  triturates,  y±  grn.  each,  instead,  so  that  the  patient  may 
take  one  with  each  dose  of  the  medicine."  I  am  sure  the 
doctor  would  feel  under  great  obligation  to  the  pharmacist 
for  pursuing  such  a  course. 

207.     Sodii  Hyposulphit  ..........................  3  ij 

Ac.  Sulphur.  Diluti  .........................  3  iij 

Glycerini   ..................................  3  iv 

Aquae  ..............................  q.s.  ad  §  iij 

S.  :  3  j  in  cup  of  water,  for  rinsing  mouth  ;  also  internally, 
3  times  a  day. 

This  prescription  is  incompatible,  and  cannot  be  dispensed  ; 
either  the  first  or  second  ingredient  must  be  left  out. 

Sulphuric  acid  decomposes  the  sodium  hyposulphite  (which 
is  chemically  sodium  thiosulphate,  and  is  now  so  designated 
officially)  with  the  precipitation  of  sulphur  and  the  evolu- 
tion of  sulphur  dioxide.  The  reaction  is  as  follows  : 

+  H.SO*  =  Na,S04  +  S  +  SO,  +  H,0. 


208.    Pepsini  Pun  .............................  gr.  vi 

Sodii  Bicarbon  ............................  gr  iij 

Mf  .  pulv.  Tal.  Dos.  xx. 

S.:    One  t.i.d.  after  meals. 

Pepsin  is  considered  absolutely  incompatible,  therapeutic- 
ally,  with  sodium  bicarbonate  or  any  other  alkali.  The  di- 
gestive power  of  pepsin  i$  supposed  to  be  destroyed  by  con- 


PRESCRIPTION  INCOMPATIBILITIES          123 

tact  with  an  alkali.  Quite  likely  that  this  is  the  case.  But  I 
know  many  physicians  who  continue  to  prescribe  pepsin  with 
alkalies,  because  they  claim  they  get  good  results  from  the 
combination.  This  reasoning  is  about  as  follows:  The  gas- 
tric juice  always  contains  hydrochloric  acid  (and  where  it 
does  not,  like  in  cancer,  then  pepsin  will  be  of  little  avail, 
anyhow),  which  neutralizes  the  alkaline  medium,  leaving 
the  pepsin  free  to  exert  its  proteolytic  influence.  But,  some 
may  say,  experiments  appear  to  show  that  the  proteolytic 
power  of  pepsin,  which  has  been  in  contact  with  an  alkali, 
is  lost  forever;  that  even  after  neutralizing  the  alkali  and 
rendering  it  acid,  the  pepsin  refuses  to  work.  To  some 
physicians  those  experiments  are  not  conclusive.  A  test-tube 
or  a  porcelain  dish  is  very  different  from  a  living,  secreting 
mucous  membrane ;  and  it  is  just  possible  that  a  pepsin, 
whose  powers  have  become,  so  to  say,  dormant  from  treat- 
ment with  some  chemical,  may  suddenly  awaken  on  coming 
into  contact  with  such  a  membrane.  While  we  do  not  regard 
"vital  force"  with  the  same  superstitious  reverence  that  was 
accorded  it  before  the  epoch-making  year  of  1828 — the  year 
of  Woehler's  pregnant  discovery — still  we  believe  that  not 
all  vital  phenomena  can  be  or  ever  will  be  accounted  for  by 
strictly  chemical  processes,  or  expressed  in  chemical  equa- 
tions; and  he  who  sees  no  difference  between  a  test-tube  and 
a  living  stomach,  has  yet  a  good  deal  to  learn. 

209.    Pepsini 3  ij 

Resorcini 3  j 

Saloli 3  j 

Antiseptics  are  considered  incompatible  with  pepsin,  as 
inhibiting  its  digestive  action.  Whether  they  do  so  in  the 
stomach  is  still  sub  judice.  The  salol  will  have  no  bad  effect 
on  the  pepsin,  as  it  is  insoluble  in  the  stomach  and  passes 
into  the  bowels,  unchanged.  The  druggist  should  dispense 
this  prescription  without  any  questions,  as  it  is  only  a  case 
of  (supposed)  therapeutic  incompatibility. 


124         PRESCRIPTION  INCOMPATIBILITIES 

210.  Sol.  Fowleri 4.0 

Tr.  Nuc.  Vom 6.0 

Syr.  Ferri  lodidi 50.0 

S.:     Teaspoon ful  after  meals. 

The  potassium  carbonate  in  the  Fowler's  solution  will  pre- 
cipitate the  ferrous  iodide  as  ferrous  carbonate,  which  is 
itself  rapidly  decomposed.  It  will  also  tend  to  precipitate  the 
strychnine  and  brucine  in  the  nux  vomica.  The  iron  will 
combine  with  the  arsenite.  As  seen,  there  are  three  sources 
of  incompatibility  in  this  prescription. 

211.  Aluminis f>  ss 

Ac.  Tannici 3  ij 

Glycerin!   3  ij 

Aquae  3  ij 

S. :     Shake  well,  and  put  teaspoonf  ul  in  cup  of  warm  water 

for  gargling. 

The  following  note  came  with  this  prescription:  "The 
mixture  at  once  turned  black;  I  made  it  up  again  with  the 
same  result.  I  made  up  similar  combinations  many  times 
before,  and  it  never  happened.  Can  you  explain  this  pecu- 
liar reaction  ? ' '  The  druggist  was  told  that  undoubtedly  the 
alum  contained  an  appreciable  amount  of  iron.  Examination 
of  a  sample  of  the  alum  proved  the  correctness  of  the  sur- 
mise. Commercial  alum  is  often  contaminated  with  iron. 

212.  Pepsini  Puri 3  ij 

Ac.  Hydrochl.  Dil 3  j 

Tr.  Gentian.  Comp. 
Elix.  Simpl. 

Aq.  Menthae  Pil aa  I  j 

S. :  Cochlear  parvum  ter  in  die,  post  cibum. 
Are  pepsin  and  alcohol  incompatible?  This  question  is 
also  answered  differently  by  the  chemists  and  by  the  clini- 
cians. The  chemists  say  alcohol  destroys  the  action  of  pep- 
sin ;  the  clinicians  say  it  makes  no  difference,  as  they  get  good 
results  from  the  elixirs  and  wines  of  pepsin.  Syme's  experi- 


PRESCRIPTION  INCOMPATIBILITIES         125 

merits  seem  to  furnish  a  satisfactory  reason  for  this  difference 
of  opinion.  He  has  shown  (Med.  moderne,  IX,  p.  53)  that 
the  alcohol  exerts  its  inhibiting  action  on  the  pepsin  when 
both  are  in  a  glass  or  similar  inorganic  vessel.  Something 
entirely  different  takes  place,  however,  when  the  glass  ves- 
sel is  replaced  by  a  moist  animal  membrane.  The  alcohol  at 
once  begins  to  diffuse  through  the  membrane,  and  in  a  short 
time  the  pepsin  begins  to  exert  its  solvent  action  on  the  al- 
bumen. In  the  experiments  made,  the  albumen  dissolved 
after  two  hours  was  nearly  equal  to  the  amount  of  albumen 
dissolved  by  pepsin  in  a  medium  containing  no  alcohol  at 
all.  He,  therefore,  concludes  that  pepsin  is  not  incompatible 
with  weak  alcoholic  media. 

213.  Ferri  et  Ammon.  Cit 31 

Potass.  lodidi 3  i 

Glycerin!   3  ss 

Aquae   ad  %  uj 

This  prescription  is  all  right.  The  iron  and  ammonium 
citrate  has  a  neutral  reaction  and  there  is  no  liberation  of 
iodine,  even  after  standing  for  a  considerable  time. 

214.  Tr.  Ferri  Chlor 3  ij 

Quin.  Sulph 3  ss 

Aquae    Creosoti    3  iv 

The  quinine  will  dissolve  in  the  water  by  the  aid  of  the 
acid  present  in  the  tincture  of  iron;  but  creosote  with  ferric 
salts  produce  a  blue  color,  changing  to  a  dirty  green  and 
brown,  with  a  brown  precipitate. 

215.  Hydrarg.  Chlor.  Mitisl 

Sodii  Chloridi  L aa  0.3 

Pulv.  Jalapae 

Tal.  Dos.  No.  Decem.  S.  Unun  mane  nocteque. 
It  is  remarkable  how  sometimes  a  hasty  statement  made 
by  an  investigator  after  insufficient  experimentation  will  gain 
circulation  in  the  pharmaceutical  press  (and  also  in  the  med- 


126         PRESCRIPTION  INCOMPATIBILITIES 

ical),  be  quoted  in  the  dispensaries,  become  incorporated  in 
text-books,  and  gain  credence  as  a  well-established  truth, 
without  anybody  taking  the  trouble  to  verify  or  disprove  the 
statement.  The  above  prescription  is  a  case  in  point.  For 
many  years  it  had  been  held  that  to  prescribe  calomel  and 
sodium  chloride  in  the  same  powder  meant  death,  or  at  least 
great  bodily  harm,  to  the  patient,  from  the  formation  of 
corrosive  sublimate.  But  is  this  so  ?  The  author  believes  the 
prescription  is  perfectly  compatible,  and  that  no  corrosive 
sublimate  is  formed.  In  twenty-four  consecutive  experiments 
he  could  find  no  more  than  insignificant  traces  of  HgCl2, 
such  as  can  also  be  found  by  triturating  calomel  by  itself,  or 
with  water,  or  with  some  other  inert  substance  like  silica 
or  kaolin.  The  author  was  among  the  first  to  establish  this 
fact,  and  to  teach  his  students  to  answer  accordingly  at  exami- 
nations. The  Latin  signature  means :  ' '  one  powder  morning 
and  night." 

216.    Hydrarg.  Chlor.  Corros gr.  iv 

Potass.  lodidi  3  ij 

Ferri  et  Ammon.  Citr 3  i 

Tr.  Nucis.  Vom 3  ij 

Tr.  Cinchon.  Compos ad    3  *v 

In  many  prescriptions  we  are  confronted  with  a  condition 
of  affairs  similar  to  the  one  in  which  a  physician  is  when 
he  is  face  to  face  with  an  incurable  malady.  He  knows  the 
trouble,  but  can  offer  no  remedy.  In  the  above  prescription 
we  know  exactly  what  the  trouble  is,  but  we  know  at  the 
same  time  that  there  is  no  way  of  improving  it.  The  sources 
of  trouble  or  incompatibility  in  this  prescription  are  numer- 
ous. First  of  all  it  is  well  to  be  aware  that  ammonio-ferric 
citrate,  while  rapidly  and  completely  soluble  in  water,  is  in- 
soluble in  alcohol;  and  as  compound  tincture  of  cinchona  is 
made  with  a  menstruum  consisting  chiefly  of  alcohol,  the  salt 
will  not  dissolve.  That  is  number  one.  Second,  the  corro- 
sive sublimate  and  potassium  iodide  precipitate  the  alka- 
loids of  both  the  cinchona  and  the  nux  vomica.  Even  if  there 


PRESCRIPTION  INCOMPATIBILITIES          127 

were  no  nux  vomica  in  the  prescription,  the  precipitation  of 
the  cinchona  alkaloids  alone  would  make  the  mixture  some- 
what dangerous;  because  it  is  well  to  remember  that  when 
HgCl2-f  KI  (iodohydrargyrate  of  potassium)  precipitates 
an  alkaloid,  it  becomes  precipitated  with  it,  in  the  form  of 
a  double  salt.  So  that  the  mercury  would  be  in  the  form  of 
a  precipitate,  and  the  patient  might  get  too  much  at  one 
dose.  A  third  cause  of  unsightliness  would  be  in  the  black, 
inky  color,  produced  by  the  action  of  the  tannic  acid  pres- 
ent in  the  cinchona,  bitter  orange-peel,  etc.,  on  the  ferric  salt. 
In  short,  looked  at  from  whatever  point  of  view,  the  above 
is  a  bad  combination,  and  it  is  advisable  to  refuse  to  dispense 
it. 

217.  Bism.  Subnitrate  i    „ 

Liver  of  Sulphur  }of  each 5l 

Zinc  Sulphate gr.  x  . 

Lead  Water  51 

Rose  Water I  iij 

A  series  of  reactions  will  take  place  in  this  prescription. 
Zinc  sulphate  and  lead  water  will  produce  a  white  precipitate 
of  lead  sulphate,  and  zinc  acetate  will  remain  in  solution. 
The  liver  of  sulphur,  which  consists  of  several  potassium 
sulphides,  will  produce  zinc  sulphide  (which  is  white),  and 
with  the  lead  the  black  sulphide  of  lead.  Some  black  bis- 
muth sulphide  will  also  be  formed  and  there  will  also  be 
a  slight  precipitation  of  sulphur. 

218.  Ferri  et  Quin.  Cit.  Solubilis 3  ij 

Potass.  lodidi 5  iv 

Syr.  Sarsap.  Compos 3  ss 

Aquae  Menth.  Pip ad  I  iv 

The  potassium  iodide  precipitatas  the  quinine  as  quinine 
iodide;  there  is  also  a  slight  liberation  of  iodine,  due  to  the 
fact  that  ferric  salts,  namely,  those  having  an  acid  reaction, 
decompose  potassium  iodide  with  the  liberation  of  iodine, 
while  they  become  reduced  to  ferrous  compounds. 


128          PRESCRIPTION  INCOMPATIBILITIES 

219.  Laetopeptini    3  j 

Sodii  Bicarbon 3  ss 

Hydrarg.  Chlor.  Mitis gr.  v 

Antipyrini gr.  xv 

Sodii  Phosphatis  • 3  j 

Caffein.  Citratae gr.  xv 

Sodii  Bromidi  3  ij 

Ft.  pulveres  No.  XII. 

The  sodium  bromide  is  incompatible  with  the  calomel,  con- 
verting it  into  mercuric  bromide  and  mercurous  oxide.  The 
antipyrine  is  slightly  incompatible  with  the  calomel;  the 
sodium  phosphate  when  triturated  with  the  citrated  caffeine 
and  the  other  salts  liberates  some  of  its  water  of  crystalliza- 
tion, of  which  it  contains  12  molecules  and  converts  the  whole 
into  a  pasty  mass ;  the  small  amount  of  HC1  contained  in  the 
lactopeptine  and  the  citric  acid  in  the  caffeine  will  liberate 
some  C02  from  the  sodium  bicarbonate,  etc.  In  short,  this 
prescription  is  absolutely  non-dispensable. 

220.  Ac.  Salicylic! 5  v 

Sodii  Bicarbonatis 3  iss 

Aquae  Menthae  Pip 3  iij 

"On  putting  the  ingredients  in  a  mortar,  considerable  ef- 
fervescence was  noticed,  but  when  the  effervescence  was  over, 
a  white  powder  remained,  which  no  amount  of  rubbing  or 
shaking  could  dissolve.  What  was  the  powder?  Was  it  a 
new  compound  or  was  it  the  salicylic  acid?"  Thus  runs  the 
tale  of  one  of  my  correspondents.  No,  the  powder  was  neither 
a  new  compound,  nor  was  it  the  salicylic  acid.  It  is  true, 
salicylic  acid  is  but  very  slightly  soluble  in  water;  but  in 
the  presence  of  sodium  bicarbonate  and  water  a  chemical 
action  takes  place  and  sodium  salicylate  is  formed.  Sodium 
salicylate  is  soluble  in  less  than  one  part  of  water.  Five 
drams  of  salicylic  acid  will  combine  with  three  drams  of  so- 
dium bicarbonate  (molecular  weight  of  salicylic  acid  =  138, 
molec.  weight  of  sod.  bicarbonate  =  84,  which  gives  us  prac- 


PRESCRIPTION  INCOMPATIBILITIES          129 

tically  the  proportions  of  5  to  3)  ;  there  are  still  left  9  drams 
of  NaHCOg.  Sodium  bicarbonate  being  soluble  in  12  parts 
of  water,  it  would  require  108  drains,  or  13y2  ounces,  of  water 
to  dissolve  the  remainder  of  the  sodium  bicarbonate  in  this 
prescription.  There  are  only  3  ounces  of  menstruum  ;  nearly 
an  ounce  will  be  used  up  for  keeping  the  sodium  salicylate 
in  solution  ;  in  the  balance  only  about  1^>  or  at  most  2  drams 
of  sodium  bicarbonate  will  dissolve.  There  are  still  seven 
drams  left  undissolved. 

This  solution  will  turn  dark  after  standing  for  some  time. 
All  salicylates  are  likely  to  turn  dark  and  especially  so  in 
the  presence  of  an  alkali.  I  have  been  frequently  asked  why 
physicians  should  prescribe  such  combinations  and  not  order 
sodium  salicylate  instead.  The  reason  is  that  experience  has 
demonstrated  that  such  fresh  preparations  are  more  acceptable 
to  some  stomachs  than  the  regular  sodium  salicylate.  One  of 
the  causes  of  this  acceptability  is  the  carbon  dioxide  with 
which  the  solution  is  saturated. 

221.     Syr.  Ac.  Hydriodicfl 

Aquae  Oxygenii        I  ......................  aa  3  j 

Glycerini 

-> 

Aquae  Menthae        J 
Aqua  oxygenii  is  a  synonym  for  hydrogen  dioxide. 
This  decomposes  the  hydriodic  acid,  liberating  iodine,  and 
becoming  itself  decomposed  into  water.     The  equation  is  as 
follows  : 


Syr.  Aurantii  Cort  ->  ,  .  .aa      iss 

'  ' 


If  there  be  an  excess  of  dioxide  the  liberated  oxygen  may 
oxidize  the  hydriodic  acid  to  a  higher  compound. 

222.    Liq.  Hydrogenii  Dioxidi  .................        %  ij 

Kali  Hypermanganici  .........  .  .........       gr.  xxx 

Aquae  Destill  ...........................       I  iv 

Peroxide  of  hydrogen  is  an  antiseptic,  and  so  is  potassium 
permanganate.     Hydrogen  dioxide  and   potassium  perman- 


130          PRESCRIPTION  INCOMPATIBILITIES 

ganate  are  absolutely  incompatible.  The  solution  of  potas- 
sium permanganate  is  decolorized  by  the  peroxide,  with  the 
formation  of  a  precipitate  of  manganese  dioxide  and  potas- 
sium manganate. 

The  chemical  reaction  may  be  represented  by  the  follow- 
ing equation : 

2KMnO*  +  2IL02  =  KJVtnO*        MnO,  +      2ILO  +  20. 
Potass.     Hydrogen     Potassium     Mangan.       Water     Oxygen 
Permangan.    Dioxide     Manganate   Dioxide 

The  peroxide  of  hydrogen  usually  containing  a  small  quan- 
tity of  acid  for  its  preservation,  a  small  quantity  of  man- 
ganous  sulphate  will  also  be  found.  The  reaction  is: 

2KMnO<  +     5H.O.+     3H2S04  =    K^SO*  + 

Potass.  Hydrogen     Sulphuric     Potass. 
Permangan.      Dioxide        Acid  Sulphate 

2MnS04  +  SILO  +  50, 

Manganous  Water    Oxygen 
Sulphate 

Of  course,  the  prescription  should  not  be  dispensed. 

223.     Aconitini  gr.  j 

Div.  in  pil.  No.  24.  S.:  One  pill  twice  a  day. 
The  author  received  this  prescription  with  a  note  asking 
whether  the  dose  was  too  large.  There  is  not  a  single  drug 
or  chemical  in  the  entire  range  of  the  materia  medica  the 
dosage  of  which  has  caused  so  much  trouble  to  physician  and 
to  dispenser  alike  as  aconitine  has;  and  this  is  due  to  the 
fact  that  there  is  no  other  drug  which  varies  so  much  in 
strength  as  do  various  samples  of  aconitine.  Of  two  samples 
of  aconitine  one  may  be  many  times  stronger  than  the  other. 
It  is  time  for  physicians  and  pharmacists  to  know  that  sub- 
stances like  aconitine,  digitalin,  etc.,  are  not  absolutely  dis- 
tinct entities  such  as  potassium  iodide  or  sodium  bromide. 
The  name  of  the  manufacturer  is  of  little  importance  when 
the  common  chemicals  are  ordered,  but  it  makes  all  the  dif- 
ference in  the  world  in  the  case  of  aconitine  or  of  digitalin. 
I  always  claimed  that  in  ordering  aconitine,  the  kind  wanted 


PRESCRIPTION  INCOMPATIBILITIES          131 

(whether  amorphous  or  crystallized)  and  the  name  of  the 
manufacturer  should  always  be  specified.  Otherwise  a  dose 
might  be  prescribed  which  will  one  time  produce  no  effects 
whatsoever,  and  the  next  time  prove  fatal  or  nearly  so.  In 
the  last  edition  of  "Hager's  Handbuch"  (1899,  page  151)  it 
is  distinctly  advised  to  buy  aconitine  preparations  directly 
from  the  manufacturer  "in  original  packages,  having  it 
stated  exactly  what  quality  the  preparation  is  and  what  its 
maximum  dose." 

Aconitine  cryst.  Merck,  and  aconitine  Duquesnel,  are  prac- 
tically identical,  and  their  dose  may  be  stated  to  be  from 
1-600  to  1-100  grn.  Under  no  consideration  would  the  writer 
prescribe  or  advise  a  pharmacist  to  dispense  more  than  1-100 
grn.  of  crystallized  aconitine ;  he  may  go  as  high  as  one  1-60 
provided  he  is  sure  that  the  physician  is  fully  aware  of  the 
potency  of  the  drug.  The  amorphous  variety  may  be  pre- 
scribed in  larger  doses.  What  answer  was  given  to  the 
inquirer  regarding  the  above  prescription?  On  looking  into 
the  medical  directory,  it  was  found  that  the  physician  who 
wrote  the  prescription  belonged  to  the  eclectic  school;  there 
was  then  no  doubt  that  it  was  the  eclectic  resinoid  powder 
that  was  intended.  Of  this  the  dose  is  from  1-24  to  1-12  grn., 
and  as  much  as  %  grn.  may  be  given.  The  druggist  was 
thus  advised,  and  subsequent  inquiry  from  the  physician 
proved  that  this  was  correct. 

224.    Quinin.  Sulph 3  ij 

Ac.  Sulph.  Dil q.s. 

Salicini    3  vi 

Syrupi   * 3  i 

Aquae  ad  |  iv 

A  correspondent  writes  that  on  mixing  the  quinine  with 
the  acid  and  some  water  he  obtained  a  perfectly  clear  solu- 
tion, but  on  adding  the  salicin  a  precipitate  formed  at  once. 
"What  was  the  precipitate  due  to?  Was  quinine  salicylate 
formed  or  was  salicylic  acid  thrown  out  from  solution  by  the 


132          PRESCRIPTION  INCOMPATIBILITIES 

sulphuric  acid?"  Some  people  will  dig  very  deep  for  a 
cause  when  the  latter  is  as  plain  as  daylight.  No  chemical 
reaction  of  any  kind  is  formed  between  the  salicin  and  the 
quinine  or  the  salicin  and  the  sulphuric  acid;  in  fact,  no 
precipitate  of  any  kind  is  formed.  What  was  considered  a 
precipitate  was  simply  the  excess  of  the  undissolved  salicin. 
Salicin  is  soluble  in  about  28  parts  of  water;  consequently 
only  about  a  dram  will  dissolve  in  the  menstruum  of  this  pre- 
scription; 5  drams  will  be  in  suspension;  it  is  this  undis- 
solved portion  that  our  correspondent  mistook  for  a  precipi- 
tate. 

225.    Cocain.  Hydrochlor gr.  vj 

Quinin.  Sulph.->  ._      3  gg 

Tannini 

Menthol   3  i 

Aquae  Rosae  q.s.  ad      5  VJ 

S.:    Use  as  a  gargle. 

What  possible  benefit  can  a  patient  derive  from  using 
such  a  conglomeration  ?  I  am  convinced  that  not  only  would 
he  derive  no  benefit,  but  his  condition  would  become  aggra- 
vated. The  cocaine  would  be  precipitated,  as  cocaine  tan- 
nate,  which,  being  insoluble,  would  have  no  effect.  The  qui- 
nine would  be  present  partly  as  quinine  sulphate  and  partly 
as  quinine  tannate,  both  insoluble ;  the  menthol  which  is  here 
in  excessive  dose  is  insoluble  in  water,  and  on  reaching  the 
fauces  and  pharynx  in  an  undissolved  state  would  prove 
intensely  irritating;  even  the  astringent  effect  of  the  tannic 
acid  would  be  to  some  extent  destroyed,  as  a  part  of  it 
would  be  used  up  to  form  insoluble  compounds  with  the 
alkaloids.  In  short,  the  combination  is  a  worthless  one;  the 
patient  would  have  fared  much  better  if  the  physician  had 
prescribed  half  a  dram  of  tannic  acid  in  6  ounces  of  water. 
Had  the  prescription  been  for  internal  use  there  might  yet  be 
some  shadow  of  excuse  for  putting  it  up;  we  would  say: 
"Well,  the  gastro-intestinal  juices  will  decompose  the  insol- 


PRESCRIPTION  INCOMPATIBILITIES          133 

uble  combinations,  and  their  constituents  will  produce  their 
effect."  For  a  gargle,  however,  the  prescription  should  not 
be  put  up. 

,226.    Boracis   5  iv 

'  Pulv.  Acaciae 3  i 

Aquae  Rosae 3  iy 

S. :     For  external  use. 

This  is  a  well  known  incompatibility.  If  the  borax  is  dis- 
solved in  a  portion  of  the  water  and  the  acacia  in  another 
portion  and  the  two  solutions  are  mixed,  a  thin,  gelatinous 
precipitate  will  result  which  will  make  the  mixture  altogether 
unpresentable.  There  is  no  way  of  obviating  the  difficulty. 
It  is  an  instance  of  true  incompatibility. 

227.  Sodii  Boratis 3  ij 

Pulv.  Acaciae  3  i 

Syrupi   3  8S 

Aquae  Menthae  Pip ad  3  UJ 

S.:     Teaspoonful  every  4  hours. 

The  two  principal  ingredients  in  this  prescription  are  the 
same  as  in  the  previous  one.  Nevertheless  this  prescription 
can  be  dispensed  because  it  contains  another  ingredient, 
namely,  syrup,  which  prevents  the  gelatinization  of  the  aca- 
cia. The  proper  way  to  make  it  up  is  to  dissolve  the  borax 
in  the  peppermint  water,  the  acacia  in  the  syrup  and  mix 
the  two  solutions. 

228.  Aspirini  gr.  v 

Hexamethylenaminae    gr.  v 

Mf.  caps.  No.  1.    Tal.  Dos.  xxiv. 
S.:     One  three  times  a  day  after  meals. 

One  druggist  hesitated  to  dispense  this  prescription  be* 
cause  he  had  heard  or  read  somewhere  that  aspirin  was  in- 
compatible with  hexamethylenamin.  This  is  nonsense.  I 
have  seen  these  capsules  dispensed  hundreds  of  times  without 
any  trouble.  It  is  not  necessary  to  triturate  the  aspirin  and 


134          PRESCRIPTION  INCOMPATIBILITIES 

the   hexamethylenamin   very   vigorously;   simply   mix   them 
lightly  and  fill  the  capsules. 

229.  Atophan 

Urotropin  aa   0.3  « 

Mf.  Pulv.     Tal.  Dos.  xii. 
One  powder  in  glass  of  water. 

The  same  is  true  of  this  prescription.  There  is  nothing 
incompatible  between  atophan  and  urotropin.  The  druggist 
need  have  no  hesitation  in  dispensing  the  prescription. 

230.  Sodii  Boratis 3  iss 

Ac.  Salicyl 3  i 

Glycerin!  3  x 

Syrupi q.s.  ad  3  iv 

The  ordinary  druggist  will  simply  mix  the  borax  and  the 
salicylic  acid  with  the  syrup,  overlooking  the  fact  that  all 
the  salicylic  acid  is  not  soluble  in  the  menstruum.  The 
proper  way  to  dispense  this  prescription  is  to  dissolve  the 
salicylic  acid  in  a  part  of  the  glycerin  by  the  aid  of  a  gentle 
heat  and  the  borax  in  the  other  half  of  the  glycerin.  The 
solutions  are  then  mixed  and  the  syrup  added.  Made  this  way 
a  clear  solution  is  obtained  without  any  undissolved  salicylic 
acid  in  suspension.  Another  way  quite  permissible  would  be 
to  dissolve  the  salicylic  acid  in  a  small  quantity  of  alcohol,  dis- 
solve the  borax  in  the  glycerin  by  the  aid  of  a  gentle  heat,  mix 
the  solutions  and  add  the  syrup. 

231.  Liquor.  Cresolis  Compos 5  iv 

Hydrarg.  Bichlor gr.  vii 

Potass.  Permangan 3  iv 

3  i  in  two  quarts  of  water  for  douche. 

This  prescription  forms  an  incompatible  mess.  The  reac- 
tions that  take  place  in  it  are  too  numerous  to  mention.  (1) 
The  potassium  permanganate  is  incompatible  with  the  cresol 
solution.  (2)  The  mercuric  chloride  is  incompatible  with 


PRESCRIPTION  INCOMPATIBILITIES          135 

the  cresol  solution.  (3)  The  potassium  permanganate  is  in- 
compatible with  the  mercuric  chloride,  and  (4)  The  mercuric 
chloride  is  incompatible  with  the  cresol  solution.  The  proper 
way  to  make  up  this  prescription  is  not  to  make  it  up  at  all 
and  to  notify  the  physician.  I  know  that  it  is  not  an  ex- 
tremely pleasant  thing  to  have  to  send  around  or  to  call  up 
the  physician  and  tell  him  that  his  prescription  cannot  be 
made  up ;  he  generally  gets  ruffled.  But  in  a  case  like  this, 
nothing  else  is  left  to  be  done.  The  prescription  is  too  in- 
compatible to  be  dispensed,  and  to  leave  out  the  potassium 
permanganate,  for  instance,  might  put  the  druggist  into 
greater  trouble  with  the  physician  than  to  attempt  to  explain 
matters  beforehand. 

232.  Sodii  Salicyl 3  iv 

Urotropini    3  ij 

Spir.  Aetheris  Nitrosi 3  i 

Aquae  3  v 

The  only  difficulty  with  this  prescription  is  that  after  a 
little  while  it  acquires  a  dark  color  on  account  of  the  action 
between  the  nitrous  ether  and  the  salicylate  of  sodium.  There 
is  no  incompatibility  between  the  salicylate  of  sodium  and  the 
urotropin. 

233.  Diuretini    3  i 

Potassii  lodidi 3  ij 

Hydrarg.  Chlor.  Corros gr.  ij 

Aquae  q.s.      I  iij 

S.:     314  times  a  day. 

This  prescription  is  incompatible.  The  mercuric  chloride 
and  the  potassium  iodide,  which  as  we  know  form  iodohydrar- 
gyrate  of  potassium,  will  either  at  once  or  eventually  precipi- 
tate the  theobromin.  If  there  was  no  mercuric  chloride  in 
the  prescription  it  could  be  dispensed  with  a  shake  label. 
But  it  is  rather  risky  to  dispense  a  prescription  which  con- 
tains mercuric  chloride  as  a  precipitate. 


136          PRESCRIPTION  INCOMPATIBILITIES 

234.  Phenacetini 4.0 

Tr.  Ferri  Chloridi  8.0 

Elix.  Simpl 30.0 

Aquae   30.0 

S. :     Teaspoonful  every  3  hours. 

While  the  therapeutic  wisdom  of  prescribing  phenacetin 
and  tincture  of  ferric  chloride  in  the  same  mixture  may  well 
be  questioned,  still  there  is  nothing  incompatible  in  the  com- 
bination and  the  druggist  need  have  no  hesitation  in  dis- 
pensing it.  The  proper  way  is  to  rub  the  phenacetin  by 
itself  carefully  in  a  mortar,  then  add  the  simple  elixir  grad- 
ually, then  the  tincture  of  iron  and  then  the  water.  Under 
certain  circumstances  a  red  color  may  result  from  the  action 
of  the  phenacetin  on  the  tincture  of  iron. 

235.  Protargol    2.0 

Aquae   100.0 

S.:    For  external  use  only. 

There  is  of  course  nothing  incompatible  between  protargol 
and  water,  but  the  way  of  dispensing  a  prescription  contain- 
ing protargol  makes  quite  a  difference.  If  you  put  the  pro- 
targol in  a  mortar  and  begin  to  rub  it  with  water  you  will 
get  lumps.  The  same  thing  will  happen  if  you  put  the  pro- 
targol in  a  bottle  and  fill  it  with  water  and  shake  it.  There 
is  only  one  way  of  making  a  protargol  solution  properly,  and 
that  is  to  measure  the  prescribed  quantity  of  water  in  a  grad- 
uate, and  sift  the  protargol,  i.  e.,  spread  it  over  the  water 
with  a  sifting  motion,  and  let  it  stand  until  dissolved.  A 
clear  solution  is  then  obtained.  The  addition  of  glycerin  to 
the  protargol  to  aid  in  the  solution  is  not  permissible. 

236.  Ac.  Citrici   50.0  gram 

Kali  Carbonic!   q.  s.  ad  saturationem 

Aquae    500.0  gms. 

S.:    §  ss  quaqua  nora  secunda. 

A  druggist  from  Milwaukee  sends  in  the  above  prescription 
and  asks  for  a  thorough,  clear  explanation.  He  writes  that 


PRESCRIPTION  INCOMPATIBILITIES          137 

he  gets  many  such  and  similar  prescriptions  and  is  sorely 
puzzled  to  know  how  much  to  take  of  the  potassium  carbonate 
or  of  any  other  ingredient,  "What  way  is  there  to  find  out 
how  much  of  one  substance  it  takes  to  saturate  another  ?  Is 
there  an  easy  rule,  by  which  one  can  always  go  ?  I  have  never 
studied  chemistry."  The  question  that  our  correspondent 
brings  up  is  a  very  important  one.  In  a  prescription  like 
the  above  ignorance  may  lead  to  disagreeable  results.  If  we 
add  too  little  potassium  carbonate,  the  solution  will  be  in- 
tensely acid,  so  that  the  patient  may  not  be  able  to  take  it. 
If  we  add  too  much,  the  result  may  be  still  worse,  as  potas- 
sium carbonate  is  quite  poisonous.  And  still  we  cannot  go 
here  into  a  full  explanation  of  the  subject.  To  do  so  would 
mean  to  give  an  exposition  of  the  principles  of  chemistry. 
We  can  only  give  an  outline  of  the  method  of  arriving  at  the 
solution  of  such  and  similar  problems.  The  equation  between 
citric  acid  and  potassium  carbonate  is  as  follows: 
2H.C  JLO,  +  3K,CO,  =  2K,C.H.C>T  +  SCO,  +  SILO 

That  is,  2  molecules  of  citric  acid  require  for  neutraliza- 
tion molecules  of  potassium  carbonate.  The  mol.  weight  of 
citric  acid  is  210,  of  potassium  carbonate,  138.  Twice  210 
equals  420 ;  three  times  138  is  414.  In  other  words  420  parts 
of  citric  acid  require  414  parts  of  potassium  carbonate,  or 
almost  part  for  part.  In  this  case  it  will  be  quite  proper 
to  take  50  grams  of  potassium  carbonate. 

237.     Acidi  Salicylic! gr.  xx 

Ferri  Pyrophos gr.  v 

Sodii  Phosphatis 3  i 

Aquae   q.s.  ad    3  ss 

S. :     For  one  dose. 

The  appearance  of  a  mixture  prepared  from  the  foregoing 
ingredients  will  vary  according  to  the  way  it  is  compounded. 
The  formula  is  one  which  originated  in  the  New  York  Hos- 
pital, and  the  pharmacist  recommended  the  following  method 
of  preparing  the  mixture:  Dissolve  the  sodium  phosphate 


138          PRESCRIPTION  INCOMPATIBILITIES 

in  water  heated  to  the  boiling  point,  and  in  the  solution  so 
formed  dissolve  the  salicylic  acid  and  ferric  pyrophosphate, 
heat  being  applied  if  necessary  to  complete  the  solution. 

Made  in  this  way  the  mixture  assumes  a  beautiful  claret 
color,  perfectly  clear  and  transparent.  It  probably  owes  its 
color  to  the  formation  of  a  slight  amount  of  ferric  salicylate 
which  passes  into  solution. 

238.  Liquor.  Hydrogenii  Dioxidi   %  iv 

Glycerin!   3  *J 

S.:    3  ij  after  each  meal. 

Those  who  see  incompatibilities  where  none  exist  have  as- 
serted that  hydrogen  dioxide  and  glycerin  are  incompatible. 
There  is  absolutely  nothing  incompatible  between  the  two 
ingredients  and  a  mixture  of  them  may  be  kept  for  several 
months  without  any  fear  of  deterioration.  We  so  stated  in 
a  previous  prescription,  but  there  is  no  harm  in  an  occasional 
repetition. 

239.  Ac.  Carbolic! 

Tr.  lodi  aa  gr.  xv 

Muc.  Acaciae    3  i 

Alcoholis  (pur!)   5  v 

A  disagreeable  looking  mess.  Mucilage  of  acacia  spoils  the 
combination  without  doing  any  good.  It  should  be  left  out 
without  any  question.  Without  the  mucilage  the  prescrip- 
tion is  all  right. 

240.  Adrenalin!  Chlor 3  ss 

Argent!  Nitratis gr.  v 

Aquae   3  v 

S. :    Inject  3  times  a  day. 

An  absolutely  incompatible  prescription.  The  chloride  of 
the  adrenalin  precipitates  the  silver  nitrate  in  the  form  of 
silver  chloride.  The  adrenalin  also  reduces  the  silver  to 
metallic  silver  while  the  adrenalin  itsftlf  is  oxidized  and  be- 
comes worthless.  An  example  of  incompatibility  which  is 
beyond  any  hope  of  relief  or  improvement.  The  physician, 


PRESCRIPTION  INCOMPATIBILITIES          139 

who  evidently  had  to  deal  with  a  very  congested  urethra, 
perhaps  one  that  bleeds  on  the  injection  of  silver  nitrate, 
tries  to  obviate  the  undesirable  effects  of  this  salt  by  using 
adrenalin.  But  he  only  spoils  both  chemicals.  It  he  does  want 
to  get  the  effects  of  both  the  silver  nitrate  and  the  adrenalin 
chloride,  the  only  way  to  do  it  is  to  make  them  up  in  two 
separate  injections  and  tell  the  patient  to  use  the  adrenalin 
chloride  solution,  say  five  or  ten  minutes  after  the  silver 
nitrate  injection.  The  doctor  orders  " adrenalin  chloride," 
but  what  he  means,  of  course,  is  the  solution  of  adrenalin 
chloride,  1  to  1,000. 

241.  Potass.  Bromitli  3  ss 

Potass.  Citratls   B  i 

Spir.  Chloroform! 3  iii 

Aquae     ad  5  viii 

S. :      5  ss  per  dose. 

The  salts  and  the  water  precipitate  the  chloroform  out  of 
the  spirit.  May  be  dispensed  with  a  shake  label,  but  it  is 
a  disagreeable  prescription. 

242.  Ung.  Zinci  Ox 3  i 

Aquae  Calcis 5  "i 

Mf.  ung. 

The  doctor  orders  to  make  an  unguentum.  It  cannot  be 
done.  You  cannot  make  an  ointment  from  one  ounce  of 
zinc  oxide  ointment  and  three  ounces  of  lime  water.  The 
proper  way  to  dispense  this  prescription  is  to  melt  the  zinc 
oxide  ointment  and  mix  it  with  the  lime  water  in  a  bottle, 
shaking  it  well.  That  will  make  a  nice  thin  cream. 

243.  Spir.   Camphorae    3  ii 

Aquae  Menth.  Pip 3  "i 

3  i  every  hour. 

On  mixing  the  spirit  of  camphor  with  the  water  the  cam- 
phor will  precipitate  |>ut.  There  is  no  way  of  obviating  it 
except  by  making  an  emulsion.  It  would  be  better  to  order 
the  two  drams  of  spirit  of  camphor  separately  and  tell  the 


140         PRESCRIPTION  INCOMPATIBILITIES 

patient  to  use  five  minims  dropped  in  a  teaspoonful  or  table- 
spoonful  of  water.  Then  the  patient  gets  the  proper  dose 
each  time.  To  dispense  it  the  way  it  is  written,  the  camphor 
may  not  be  properly  distributed  and  the  patient  may  get 
unequal  doses  of  the  camphor  in  each  teaspoon.  To  take 
the  proper  amount  of  camphor  (twelve  grains),  dissolve  it 
in  some  olive  oil,  add  powdered  acacia  and  make  up  an 
emulsion  with  peppermint  water  would  be  all  right  as  far 
as  suspending  the  camphor  is  concerned.  But  that  would 
be  taking  toft  many  liberties  with  the  prescription. 

244.  Aluminis     3  i 

Boracis    3  i 

Glycerini     5  i 

Aquae ad   3  yiii 

S. :     Use  as  a  gargle. 

While  borax  with  alum  gives  a  precipitate  of  aluminum 
hydroxide,  still  this  prescription  may  be  dispensed.  The 
borax  is  to  be  dissolved  in  the  glycerin,  the  alum  in  the  water, 
and  the  solutions  mixed. 

245.  Aspirin! 5  ij 

Potassii  lodidi 3  iv 

Aquae 3  "J 

S.:     Teaspoon  as  directed. 

It  is  claimed  that  aspirin  with  solution  of  potassium  iodide 
is  apt  to  decompose  with  the  formation  of  hydriodic  acid.  I 
believe  this  is  a  purely  theoretical  consideration.  I  know 
a  physician  who  has  dispensed  this  prescription  very  fre- 
quently for  rheumatism  and  there  seems  to  be  nothing  what- 
ever the  matter  with  it. 

246.  Hydrarg.  Chlor.  Mit 0.x 

Kali  lodati  0.5 

M.f.  pulv.  No.  i.  Tal.  Dos.  Ix. 

S.:     One  twice  a  day,  for  3  days,  then  three  times  a 

day  for  3  days,  then  4  times  a  day. 
Most  likely  a  small  amount  of  mercuric  iodide  will  form 


PRESCRIPTION  INCOMPATIBILITIES          141 

from  the  calomel  and  potassium  iodide.  But  as  the  dose  of 
the  calomel  is  in  itself  so  small  we  need  have  no  fear  on  that 
score.  The  prescription  is  in  general  a  bad  one.  It  is  a  bad 
practice  to  prescribe  an  insoluble  substance  with  a  soluble 
one.  Potassium  iodide  is  best  prescribed  with  mercuric  chlo- 
ride or  mercuric  iodide  in  solution.  Also,  in  damp  weather 
the  powders  are  apt  to  become  wet  from  the  deliquescence 
of  the  potassium  iodide. 

247.  Ac.  Hydr.  Dil 3  i 

S. :     gtt.  x  in  water  after  meals. 

All  that  is  wrong  with  this  prescription  is  the  way  it  is 
written.  One  cannot  be  certain  what  the  doctor  meant.  Did 
he  mean  hydrochloric  acid,  hydrobromic  acid  or  hydriodic 
acid?  Hydr.  means  anything.  And  a  physician  who  will 
persist  in  writing  prescriptions  so  carelessly  should  be  de- 
prived of  his  license  for  24  hours  for  each  offense. 

248.  Quin.   Bisulph 3  i 

Sodii  Benzoatis 3  ii 

Aquae    3  IV 

S.:     Teaspoonful  4  times  a  day. 

In  this  prescription  we  get  a  bulky  precipitate  of  quinine 
benzoate.  There  is  also  some  free  benzoic  acid.  If  instead  of 
the  quinine  bisulphate  we  use  quinine  sulphate  the  precipitate 
will  not  be  so  bulky.  Because  quinine  sulphate  being  only 
slightly  soluble  in  water,  only  a  small  amount  of  quinine 
benzoate  will  be  formed. 

249.  Quin.  Sulphatis 3  i 

Sodii  Benzoatis 3  ij 

Aquae   3  *v 

See  the  previous  prescription.  The  best  thing  is  to  rub 
up  the  quinine  sulphate  with  one-half  of  the  water,  dissolve 
the  sodium  benzoate  in  the  other  one-half,  and  mix  the  two 
solutions. 


142          PRESCRIPTION  INCOMPATIBILITIES 

250.  Sodii  Benzoatis  3  iv 

Aquae    Calcis    3  *v 

S. :     313  times  a  day. 

The  greater  part  of  the  sodium  benzoate  will  dissolve.  But 
there  will  be  a  precipitate  of  calcium  benzoate.  Of  'course  the 
mixture  will  no  longer  contain  lime  water,  the  lime  having 
combined  with  the  benzoate  to  form  calcium  benzoate.  The 
little  calcium  benzoate  in  precipitation  is  of  no  value  and 
might  as  well  be  filtered  out.  As  a  matter  of  fact  it  would 
have  been  just  as  well  for  the  physician  to  order  the  sodium 
benzoate  dissolved  in  4  ounces  of  plain  water.  If  the  physi- 
cian does  not  belong  to  that  small  type  that  gets  ruffled  at 
each  remark,  it  would  be  best  to  notify  him  of  the  incompati- 
bility. 

251.  Ac.  Salicyl 3  ij 

Glycerin!    3  ij 

Aquae   q.s.  ad  3  ii  j 

There  is  not  enough  glycerin  and  water  here  to  dissolve 
the  salicylic  acid.  Borax  increases  considerably  the  solubil- 
ity of  salicylic  acid.  There  are,  therefore,  two  ways  of  dis- 
pensing the  prescription :  to  rub  up  the  salicylic  acid  with  the 
glycerin  and  water,  allowing  as  much  to  dissolve  as  will  dis- 
solve and  leaving  the  rest  in  suspension,  dispensing  the  pre- 
scription with  a  shake  label — or  to  add  about  one  dram  of 
borax,  dissolving  the  borax  and  salicylic  acid  in  the  glycerin 
and  water  by  the  aid  of  heat.  The  prescription  can  then  be 
dispensed  as  a  clear  solution.  But  whether  the  pharmacist 
has  a  right  to .  add  the  borax  without  the  physician 's  per- 
mission is  a  question  which  cannot  be  answered  dogmatically. 

252.  Potassi  et  Sodii  Tartr 3  i 

Ac.  Sulphuric!  Arom %  iij 

Aquae  Menth.  Pip 5  ij 

S. :     3  ij  3  times  a  day  after  meals. 

The  principal  incompatibility  here  is  between  the  sulphuric 
acid  and  the  potassium  and  sodium  tartrate.  The  sulphuric 


PRESCRIPTION  INCOMPATIBILITIES          143 

acid  decomposes  the  salt,  potassium  bitartrate  precipitating. 
The  oil  of  cinnamon  and  tincture  of  ginger  (in  the  aromatic 
sulphuric  acid)  will  also  separate  out,  giving  the  mixture  a 
cloudy  appearance. 

253.  Sodii  Salicyl 5  iij 

Syrupi  Limonis    5  i 

Aquae 5  iij 

The  citric  acid  contained  in  the  syrup  of  lemon  will  decom- 
pose a  portion  of  the  sodium  salicylate,  crystals  of  salicylic 
acid  floating  in  the  mixture.  The  prescription  should  be  dis- 
pensed with  a  shake  label.  If  the  physician  gives  permission 
to  filter  out  the  precipitated  salicylic  acid  that  fact  should 
be  noted  on  the  prescription  so  that  in  repeating  the  prescrip- 
tion the  same  procedure  may  be  followed. 

254.  Sod.  Benzoatis 3  ij 

Syrupi  Limonis    3  ss 

Syr.  Ac.  Citrici   3  ss 

Aquae 3  "J 

The  remarks  made  in  the  previous  prescription  apply  with 
full  force  to  this  one.  Instead  of  salicylic  acid  precipitating 
we  will  have  benzoic  acid  precipitated  by  the  citric  acid  con- 
tained in  the  syrup  of  lemon  and  the  syrup  of  citric  acid. 

255.  Pepsini  Puri   3  iii 

Ac.  Hydrocyan.  Dil 3  iv 

Aquae ad   5  iii 

S. :     3  i    after  meals. 

If  the  pharmacist  put  up  the  prescription  as  written  the 
patient  would  probably  never  take  more  than  one  dose  of  it. 
He  would  be  dead  very  promptly  after.  Though  the  prescrip- 
tion calls  very  plainly  for  diluted  hydrocyanic  acid,  there 
is  no  doubt  that  the  physician  meant  diluted  hydrochloric 
acid,  that  it  was  simply  a  slip  of  the  pen.  Ten  minims  of 
diluted  hydrocyanic  acid  if  of  proper  strength  would  very 
likely  prove  fatal.  In  this  case  the  physician  was  called  up, 


144          PRESCRIPTION  INCOMPATIBILITIES 

he  was  full  of  thanks  and  of  course  he  said  diluted  hydro- 
chloric acid  was  what  he  meant. 

256.  Acetanilidi    3  ss 

Spir.  Aetheris  Nitrosi 3  ss 

Aquae    $  ss 

S. :      3  i  q.  2  hr.  -until  relieved. 

This  prescription  acquires  a  yellow  color,  gradually  turning 
red.  Some  complex  nitrous  compounds  are  formed  due  to  the 
reaction  between  the  acetanilid  and  the  spirit  of  nitrous 
ether.  The  compounds  formed  are  not  very,  at  all,  poisonous 
and  the  prescription  may  be  dispensed.  But  why  physicians 
will  persist  in  prescribing  acetanilid  in  a  liquid  mixture  is 
beyond  understanding.  The  only  proper  way  to  prescribe 
acetanilid  is  in  the  form  of  powders,  tablets  or  capsules. 

257.  Acetanilidi 

Resorcini  aa  15.0 

S. :     For  external  use. 

When  the  two  chemicals  are  rubbed  together  a  moist  mass 
or  a  liquid  is  obtained.  By  merely  gently  sifting  the  two 
powders  they  may  be  dispensed  as  a  powder  but  there  is 
always  danger  of  their  becoming  liquid.  Acetanilid  should 
not  be  prescribed  with  resorcin. 

258.  Acetanilidi    15.0 

Thymol    5.0 

Resorcini   5.0 

M.f.  pil.  No.  xv. 

When  thymol  is  rubbed  with  acentanilid  a  liquid  is  ob- 
tained. Acetanilid  and  resorcin  also  form  a  liquid  or  semi- 
liquid  mass.  The  prescription  is  incompatible:  it  is  impos- 
sible to  dispense  it  as  a  permanent  powder. 

259.  Acetozone   3  i 

Aquae 3  *v 

S. :     For  external  use. 

Acetozone  is  only  very  slightly  soluble  in  water,  only  1 
in  1560.  Only  a  little  over  a  grain  will  dissolve  in  four 


PRESCRIPTION  INCOMPATIBILITIES*         145 

ounces  of  water  while  here  we  have  60  grains.  It  is  also 
well  to  remember  that  acetozone  the  way  it  comes  on  the 
market  is  mixed  with  one-half  its  weight  of  an  insoluble 
absorbent  powder.  The  proper  way  to  use  acetozone  is  to 
shake  one  part  of  acetozone  with  1000  parts  of  warm  water, 
let  the  undissolved  portion  subside  and  use  the  supernatant 
liquid. 

260.  Pulv.  Cretae  Compos J  i 

Elix.  Vitriol! 3  i 

Aquae    5  iy 

S. :    3  ss  3  times  a  day. 

This  is  an  absolutely  incompatible  prescription  which  the 
merest  tyro  should  understand  and  refuse  to  dispense.  Sul- 
phuric acid  (elixir  vitrioli  is  aromatic  sulphuric  acid)  will 
decompose  the  chalk  with  the  liberation  of  a  large  amount  of 
carbon  dioxide  and  the  formation  of  the  insoluble  calcium 
sulphate  or  gypsum.  The  prescription  should  not  be  dis- 
pensed, except  by  leaving  out  the  elixir  of  vitriol.  It  is  no 
use  putting  it  in  anyway  because  it  becomes  destroyed  in  the 
chemical  reaction. 

261.  Pulv.   Rhei   Compos 3  iij 

Ac.  Hydrochlor.  dil 3  ij 

Syr.  Zingiberis 3  i 

Aquae ad  $  iv 

S. :    3  ii  after  meals. 

As  we  know,  compound  rhubarb  powder  contains  mag- 
nesium oxide.  This  will  combine  with  the  hydrochloric  acid, 
forming  magnesium  chloride.  The  physician  should  be  in- 
formed of  the  incompatibility  so  that  he  may  make  the  proper 
change  in  the  prescription. 

262.  Strychn.  Sulph gr.  % 

Ext.    Gentianae    q.s. 

M.f.  pil.  No.  xv. 

S. :     One  4  times  a  day. 
This  prescription  is  reproduced  here  because  it  caused  the 


146          PRESCRIPTION  INCOMPATIBILITIES 

writer  several  extremely  anxious  hours.  Any  pharmacist  of 
any  experience  would  understand  that  the  strychnine  sul- 
phate was  meant  to  be  divided  into  fifteen  pills.  But  the 
boss  was  out  when  the  prescription  was  presented  and  the 
junior  clerk  made  it  up,  putting  14  of  a  grain  of  strychnine 
in  each  pill.  The  patient,  a  delicate  young  woman,  took  the 
pill  at  six  o'clock  and  another  one  at  ten.  At  about  eleven 
she  woke  up  with  a  very  queer  sensation,  complaining  that 
she  was  feeling  very  funny  and  that  she  thought  she  was 
dying.  It  took  a  very  strenuous  night  of  work  with  the 
administration  of  large  doses  of  potassium  bromide  and 
chloral  before  the  patient  was  out  of  danger. 

263.  Sodii  Glycerinophosph 3  ii 

Div.  in  pulv.  No.  xii. 

S. :     One  powder  3  times  a  day. 

It  cannot  be  done.  Sodium  glycerinophosphate  is  either  in 
the  form  of  a  semi-liquid  mass  or  of  very  hygroscopic  powder. 
It  is  impossible  to  dispense  it  in  powder  form.  The  only 
way  to  dispense  sodium  glycerinophosphate  is  in  liquid  form. 

264.  Potassi  Glycerinophosph 3  i 

Div.  in  caps.  No.  xii. 

One  capsule  4  times  a  day. 

It  cannot  be  done.  Potassium  glycerinophosphate  cannot 
be  dispensed  in  capsules.  It  is  almost  a  liquid  or  extremely 
hygroscopic  powder.  It  can  only  be  dispensed  in  liquid  form. 

265.  Calcii  Glycerophosph.      "j 

Potassii          "  I aa  3  i 

Sodii  "  J 

Div.  in  pulv.  No.  xx. 
S. :     One  powder  in  water  3  times  a  day. 

Of  the  three  glycerophosphates  the  calcium  is  the  only  one 
that  is  not  hygroscopic  and  can  be  dispensed  in  powder  form. 
But  the  potassium  and  sodium  glycerophosphates  make  the 
prescription  an  impossible  one. 


PRESCRIPTION  INCOMPATIBILITIES  147 

266.  Ac.  Benzoici   3  ij 

Aquae   Calcis    3  ^J 

S.:     For  external  use. 

A  portion  of  the  benzoic  acid  will  combine  with  the  lime 
forming  calcium  benzoate,  a  small  portion  will  dissolve  with 
what  is  now  plain  water  and  the  rest  will  remain  undissolved. 
It's  an  exceedingly  poor  prescription  and  the  physician  should 
be  informed  both  of  the  incompatibility  between  benzoic  acid 
and  lime  water  and  of  the  slight  solubility  of  benzoic  acid. 

267.  Ac.  Gallic!  5  ii 

Ferri  Sulph.  pulv ^  ii 

Cupri  Sulph 3  ss 

Zinci  Sulph 3  ss 

S. :     3  i  in  2  quarts  of  water. 

As  ferrous  sulphate  always  contains  some  ferric  salt  there 
will  be  a  black  precipitate  or  black  combination  between  the 
gallic  acid  and  the  ferrous  sulphate.  An  unpleasant  prescrip- 
tion, which  a  delicate  female  patient  will  not  appreciate  very 
much. 

268.  Ac.   Taunici    3  i 

Copperas     3  i 

Alum    3i 

S. :     3  i  in  quart  of  water  as  directed. 

This  powder  dissolved  in  water  will  make  a  nasty  inky 
mixture  due  to  the  action  between  the  tannic  acid  and  the 
copperas  or  ferrous  sulphate.  It  will  soil  badly  the  under- 
wear and  the  linen,  and  to  prescribe  such  a  combination  is 
equivalent  to  asking  a  patient,  and  a  female  one  at  that,  to 
syringe  herself  with  diluted  ink. 

269.  Agurin   3  i 

Sodii  Salicyl 3  ii 

Syr.  Limonis 3  * 

Aquae 3  "J 

S. :     3  i  every  two  hours. 
Agurin  is  theobromine  sodium  acetate,  which  must  not  be 


148          PRESCRIPTION  INCOMPATIBILITIES 

prescribed  with  any  acids  or  alkalies.  The  citric  acid  in  the 
syrup  of  lemon  decomposes  agurin,  precipitating  the  theo- 
bromine.  It  also  decomposes  the  sodium  salicylate,  precipi- 
tating some  salicylic  acid. 

270.  Alurninis    3  i 

Boracis    3  i 

Aquae  Chloroform! 5  vi 

S. :    Use  as  a  gargle  or  a  spray. 

There  will  be  a  precipitate  of  aluminum  hydroxid  due  to 
the  reaction  between  the  sodium  borate  and  the  alum.  That 
precipitate  might  as  well  be  filtered  out,  for  it  can  do  no 
good  as  a  gargle  or  a  spray.  It  couldn't  be  used  in  a  spray 
anyway  as  it  would  be  at  the  bottom  as  a  precipitate,  and  if 
we  shook  it  well  and  tried  to  use  it  it  would  clog  the  spray. 
The  salts  will  also  have  a  tendency  to  separate  the  chloro- 
form out  of  the  chloroform  water.  It  is  a  bad  prescription 
and  the  physician  should  be  so  informed,  of  course,  in  a  polite, 
diplomatic  manner. 

271.  Alumini  et  Pot.  Sulph 3  v 

Aquae  Calcis   3  v"i 

S. :    For  external  use  only. 

Here  we  have  a  double  incompatibility.  The  sulphate  rad- 
ical of  the  alum  will  precipitate  the  calcium  as  calcium  sul- 
phate and  the  hydroxide  of  the  calcium  will  precipitate  the 
alum  as  aluminum  hydroxide.  It  is  a  bad  prescription  and 
the  druggist  is  perfectly  justified  in  dispensing  five  drams 
of  alum  dissolved  in  eight  ounces  of  plain  water.  The  lime 
water  does  no  good,  only  mischief. 

272.  Alypini    gr.  v 

Argenti  Nitr gr.  ij 

Aquae 3  iv. 

S.:     Use  as  injection. 

"When  alypin  is  prescribed  without  any  specification,  alypin 
chloride  is  dispensed,  this  being  the  usual  combination  in 
which  alypin  appears  on  the  market.  Of  course  the  chloride 


PRESCRIPTION  INCOMPATIBILITIES          149 

will  give  a  precipitate  with  silver  nitrate  of  silver  chloride. 
If  it  is  desired  to  prescribe  alypin  with  silver  nitrate  the 
only  way  to  do  is  to  take  alypin  nitrate.  That  avoids  the 
precipitation  of  silver  chloride,  though  it  does  not  entirely 
avoid  the  reduction  of  the  silver  nitrate  to  silver  oxide  and 
metallic  silver  in  time. 

273.  Alypini   gr.  vi 

Sol.  Dobelli  I  iv 

S. :     Use  as  spray. 

Dobell's  solution  having  an  alkaline  reaction,  alkaloidal 
alypin  will  be  gradually  precipitated. 

274.  Piperazin  gr.  x 

Antipyrin gr.  iij 

M.f.  pulv.  Mitte  pulv.  tal.  dos.  xxx 

S. :     One  powder  3  times  a  day. 

"When  piperazin  and  antipyrin  are  rubbed  together  a  moist 
mass  is  obtained.  Even  piperazin  itself  being  hygroscopic 
will  become  deliquescent  when  prescribed  in  powder  form. 
The  only  proper  way  of  prescribing  the  two  chemicals  is  in 
solution. 

275.  Argenti  Nitratis    , gr.  i 

Boracis     gr.  x 

Aquae   3  i 

S. :     Swab  mouth  with  solution. 

A  precipitate  of  silver  borate  will  be  formed,  which  ren- 
ders the  prescription  useless  for  therapeutic  purposes. 

276.  Argenti   Nitratis gr,  v 

Sodii    Boratis 3  ss 

Aquae    $  ii 

S. :     For  swabbing  the  mouth. 

The  same  reaction  of  course  takes  place  in  this  prescription 
as  in  the  previous  one.  The  physician  having  failed  to  ob- 
tain any  results  from  the  first  prescription  thought  it  was 
due  to  the  small  dose  of  the  silver  and  the  borax  and  decided 


150          PRESCRIPTION  INCOMPATIBILITIES 

to  increase  them  in  the  next  prescription.  But  this  is  just  as 
bad,  because  the  silver  precipitating  out,  the  astringent  and 
specific  effect  of  the  silver  nitrate  is  lost  and  the  prescription 
is  worthless.  The  physician  should  be  informed  that  silver 
nitrate  and  sodium  borate  are  incompatible. 

277.  Argonini gr.  xij 

Zinci   Sulph gr.  xviii 

Aquae  destill %  \i 

S. :    Use  as  injection  night  and  morning. 

Argonin  is  absolutely  incompatible  with  zinc  sulphate.  A 
precipitate  is  formed.  The  only  way  to  dispense  this  pre- 
scription is  by  leaving  out  either  the  argonin  or  the  zinc 
sulphate.  But  of  course  the  proper  way  is  to  inform  the 
physician. 

278.  Argonini gr.  vi 

Ac.   Tannici    3  i 

Aquae  $  i 

S. :      For  painting  sore  throat. 

The  same  remarks  made  in  the  previous  prescription  apply 
to  this  one.  Argonin  is  incompatible  with  tannic  acid,  and 
the  two  should  never  be  prescribed  in  the  same  mixture. 

279.  Zinci  Sulph gr.  xij 

Plumbi  Acet gr.  xij 

Argonini  gr.  x 

Bism.  Subnitr 3  ij 

Aquae  |  vi 

S.:    Shake  well.    Inject  four  times  a  day. 

Argonin  is  incompatible  with  zinc  sulphate  and  with  lead 
acetate.  There  is  also  an  incompatibility  here  between  the 
zinc  sulphate  and  the  lead  acetate.  The  prescription  is  a 
bad  one.  If  the  doctor  insists  upon  having  it  dispensed  the 
way  it  is  written,  he  may  have  it,  but  he  certainly  should  be 
informed  of  the  incompatibilities  of  argonin,  and  told  that 
the  proper  way  to  prescribe  argonin  is  just  by  itself. 


PRESCRIPTION  INCOMPATIBILITIES          151 

280.  Argyrol  3  i 

Zinci  Sulph gr.  xij 

Aquae  ^  iij 

To  be  used  as  an  injection. 

Like  most  of  the  organic  silver  compounds  argyrol  is  in- 
compatible with  zinc  sulphate  and  the  two  should  never  be 
prescribed  in  the  same  mixture. 

281.  Argyrol  3  ij 

Ac.  Tannici  3  ss 

Aquae  3  i 

M.f.  sol. 

S.:     For  painting  the  throat. 

Argyrol  is  absolutely  incompatible  with  tannic  acid  and  the 
two  should  never  be  prescribed  in  the  same  mixture.  The 
proper  way  would  be  to  leave  out  the  tannic  acid  and  to 
inform  the  physician. 

282.  Hydrargyri   Bichlor gr.  ij 

Zinci  Sulph gr.  vi 

Argyrol 3  i 

Bism.  Subnitr 3  ij 

Hydrastis  Aquos  3  ss 

Aquae ad     3  v* 

S. :     Use  as  injection.     Shake  well. 

Argyrol  is  incompatible  both  with  zinc  sulphate  and  with 
mercuric  chloride.  In  fact  mercuric  chloride  and  argyrol 
form  one  of  the  finest  examples  of  incompatibility.  It  might 
not  be  out  of  place  to  state  here  that  mercuric  chloride  is 
one  of  the  most  efficient  substances  we  have  to  remove  stains 
of  argyrol  on  the  hands  or  linen. 

283.  Sol.  Donovani  I  i 

Strychn.  Sulph gr.  ij 

S.:     gtt.  x  in  water  t.  i.  d.  p.  c. 

This  is  a  dangerous  prescription.  The  mercuric  iodide  and 
the  arsenic  iodide  would  precipitate  the  strychnine  and  the 
patient  might  get  an  overdose  towards  the  end. 


152          PRESCRIPTION  INCOMPATIBILITIES 

284.  Liq.  Arseni  et  Hydrarg.  lod 3  iij 

Quin.  Hydrochlor 3  ss 

Strychn.  Sulph gr.  i 

Aquae    ad     5  iij 

S. :    3  i  ter  in  die  p.  c. 

The  same  remarks  apply  *to  this  prescription.  Both  the 
quinine  and  the  strychnipe  would  gradually  precipitate  in 
combination  with  the  arsenic  and  mercuric  iodide. 

285.  Liq.  Ac.  Arsenosi 3  iv 

Syr.  Hypophosphit.  Comp §  iv 

S. :    3  i  in  water  after  meals. 

The  hypophosphites,  it  is  claimed,  will  reduce  the  arsenous 
oxide  to  metallic  arsenic.  Still  it  is  not  a  dangerous  pre 
scription  to  dispense,  though  it  is  better  to  notify  the  physi- 
cian of  the  incompatibility. 

286.  Auri  et  Sodii  Chlor gr.  ij 

Liq.  Potass.  Arsenitis  %  i 

S. :    gtt.  x  in  water  three  times  a  day  before  meals. 

The  potassium  arsenite  reduces  the  gold  chloride  to  metal- 
lic gold.  The  prescription  is  considered  an  incompatible 
one. 

287.  Sodii  Benz 15.0 

Ac.  Phosph.  Dil 10.0 

Syr.  Limonis    25.0 

Aquae   ad 150.0 

One  would  think  that  even  the  oldest  medical  graduate  who 
forgot  or  never  knew  any  chemistry  would  not  prescribe 
sodium  benzoate  with  an  acid.  Still  this  was  written  by  a 
rather  prominent  physician.  It  was  probably  an  oversight 
on  his  part.  The  brightest  physician  will  now  and  then  make 
a  blunder  in  prescribing.  His  mind  is  occupied  with  the 
diagnosis  and  prognosis  of  the  case  before  him  and  he  cannot 
be  blamed  if  the  fine  chemical  points  are  not  always  present 
in  his  mind.  Of  course  it  is  the  duty  of  the  pharmacist  to  be 


PRESCRIPTION  INCOMPATIBILITIES          153 

on  the  lookout  and  to  call  to  the  physician's  attention  any 
dangerous  or  impossible  incompatibilities. 

288.  Sodii  Benzoatis   3  iij 

Ac.  Citrici 3  ij 

Aquae 3  iy 

S. :     3  i  4  x  a  day. 

The  same  is  true  of  this  prescription.  The  citric  acid  will 
decompose  the  sodium  benzoate  with  the  precipitation  of 
benzoic  acid. 

289.  Mist.  Rhei  et  Sodae I  vi 

Ac.  Hydrochlor.  Dil 3  ij 

S. :     Tablespoonful  after  meals. 

The  hydrochloric  acid  will  decompose  the  sodium  bicar- 
bonate present  in  the  mixture  of  rhubarb  and  soda,  with  the 
evolution  of  carbon  dioxide  and  the  formation  of  sodium 
chloride.  Of  course  nothing  dangerous  will  be  formed  here, 
but  it  would  be  a  shame  to  dispense  the  prescription  as  writ- 
ten and  the  proper  thing  would  be  to  inform  the  physician 
that  one  cannot  eat  his  cake  and  keep  it — that  one  cannot 
prescribe  an  acid  and  an  alkali  in  the  same  mixture  with  the 
expectation  of  having  both.  If  he  wants  the  alkaline  effect 
of  sodium  bicarbonate  he  should  prescribe  the  mixture  of 
rhubarb  and  soda  without  hydrochloric  acid,  and  if  he  wants 
the  effect  of  hydrochloric  acid  he  should  prescribe  it  without 
the  rhubarb  and  soda. 

290.  Mist.  Rhei  et  Sodae 3  iv 

Pepsini  Puri  3  ij 

S. :     3  i  after  each  meal. 

This  is  a  therapeutic  incompatibility.  Pepsin  is  supposed 
to  become  ineffective  when  in  contact  with  an  alkali.  Of 
course  nothing  poisonous  or  dangerous  or  unsightly  is  formed 
here  and  the  prescription  may  be  dispensed. 


154          PRESCRIPTION  INCOMPATIBILITIES 

291.  Pepsini   3  ij 

Ac.  Hydrochlor 3  ij 

Bism.  et  Amm.  Citr B  s» 

Aquae 3  *v 

The  hydrochloric  acid  decomposes  the  bismuth  salt,  splits 
it  up,  bismuth  citrate  being  precipitated.  Bismuth  and  am- 
monium citrate  should  never  be  prescribed  with  hydrochloric 
acid. 

292.  Bism.  Subnitr 3  iv 

Potass.  lodidi   3  iv 

Elix.  Pepsini  %  i 

Aquae 5  *v 

S. :    3  i  three  times  a  day. 

In  this  prescription  there  is  a  gradual  formation  of  the 
red  bismuth  iodide.  It  may  be  dispensed,  but  the  patient 
should  be  cautioned  beforehand  that  the  mixture  will  undergo 
a  certain  change  in  color. 

293.  Bism.  Subnitr 3  ij 

Ac.  Tannici  3  i 

Syrupi  3  iv 

Aquae,  q.s.  ad 3  ij 

S. :     Teaspoonful  as  required. 

In  this  prescription  there  will  be  a  gradual  formation  of 
the  yellow  tannate  of  bismuth.  It  may  be  dispensed  but  the 
patient  should  be  told  of  the  change  that  will  likely  take 
place  in  the  mixture. 

294.  Caffein.  Citr 3  i 

Sodii  Brom 3  ij 

Strontii  Brom 3  i 

Aquae  Foeniculi 3  iij 

S. :    3  i  every  three  hours. 

Here  there  will  be  a  decomposition  between  the  citrated 
caffein  and  the  strontium  bromide,  with  the  formation  of 
strontium  citrate,  which  is  insoluble  in  water  and  precipitates, 


PRESCRIPTION  INCOMPATIBILITIES          155 

295.  Caffein.  Citr.  efferves 3  ij 

S. :    3  i  in  water  as  required. 

This  prescription  was  dispensed  in  a  paper  box  and  in  a 
short  time  it  became  converted  into  a  wet  lumpy  mass.  Effer- 
vescent citrated  caffeine  is  hygroscopic  and  should  be  dis- 
pensed in  well  stoppered  bottles  only. 

296.  Airol 

Calomel   aa  5.0 

S. :     Apply  externally. 

After  a  while,  particularly  in  the  presence  of  moisture, 
there  will  be  formed  some  red  mercuric  iodide.  Airol,  which 
is  chemically  bismuth  iodo-subgallate,  rather  readily  yields 
its  iodine,  and  this  reacts  on  the  calomel  to  form  red  mer- 
curic iodide.  On  a  delicate  surface  like  the  prepuce  this 
powder  may  prove  quite  irritating  if  a  considerable  amount 
of  mercuric  iodide  is  formed. 

297.  Caffein.  Sod.  Benz 3  ij 

Ac.  Hydrochlor.  Dil 3  i 

Pepsini  3  ij 

Aquae 3  "J 

S.:    3  i  after  meals. 

The  hydrochloric  acid  splits  up  the  double  salt  of  caffeine 
and  sodium  benzoate,  and  besides  decomposes  the  sodium 
benzoate,  with  the  precipitation  of  benzoic  acid. 

298.  Bism.  Salicyl 3  iv 

Pepsini  puri 3  ij 

Ac.  Nitrohydrochlor.  Dil 3  ij 

Syr.  Zingiberis  3  vi 

Aquae,  ad 3  *v 

S. :    3  ii  after  meals. 

Bismuth  salicylate  is  incompatible  with  acids.  The  acid 
decomposes  the  salt  with  the  liberation  of  salicylic  acid.  The 
prescription  should  not  be  dispensed.  The  physician  should 
be  informed  of  the  incompatibility  and  should  leave  out  either 
the  bismuth  salicylate  or  the  acid. 


156          PBESCRIPTION  INCOMPATIBILITIES 

299.    Asaprol 3  ij 

Dermatol 3  iv 

Ac.  Nitrohydrochl.  Dil 5  ij 

Elix.  Simpl I  i 

Aquae   ad      §  iij 

S.:     Teaspoon  in  water  after  meals. 

Asaprol  is  bismuth  betanaphtholate.  Dermatol  is  bismuth 
subgallate.  Both  are  incompatible  with  acids,  which  decom- 
pose them,  splitting  off  the  betanaphthol  in  the  first  instance 
and  gallic  acid  in  the  second.  In  this  prescription  the  acid 
should  be  left  out.  The  physician  should  be  notified  so  that 
he  may  prescribe  the  acid  separately. 

30.0.    Calcis  Sulphuratae  3  i 

Div.  in  pulv.  No.  xij. 
S.:     One  powder  one  hour  after  each  meal. 

Crude  calcium  sulphide  should  not  be  dispensed  in  powders 
because  it  is  easily  decomposed  by  the  carbon  dioxide  of  the 
air,  liberating  sulphuretted  hydrogen.  The  proper  way  to 
prescribe  it  is  in  the  form  of  tablets  in  well  closed  bottles. 

301.  Spir.  Camphorae   gtt.  x 

Aquae    3  iy 

S. :    3  i  per  dose. 

On  mixing  the  two,  the  camphor  \?ill  precipitate.  As  there 
is  but  a  small  quantity  of  camphor,  a  much  better  way  would 
be  simply  to  use  the  official  camphor  water. 

302.  Camphorae. 

Ac.  Carbolici    aa  3  ij 

S. :    For  external  use. 

When  camphor  and  phenol  are  rubbed  together  a  liquid 
is  obtained.  In  this  case  the  mixture  should  be  rubbed  in  a 
mortar  until  a  perfectly  clear  solution  is  obtained.  The 
solid  phenol  should  be  taken  and  not  the  liquid,  as  the  lique- 
fied phenol  containing  as  it  does  a  certain  amount  of  water 
makes  a  turbid  solution  with  camphor. 


PRESCRIPTION  INCOMPATIBILITIES          157 

303.  Camphorae  Monobrom.  gr.  iij 

Chloralis  Hydrati  gr.  v 

M.f.  caps.  No.  1.    Tal.  Dos.  xxiv. 

S. :     One  on  going  to  bed. 

When  monobromated  camphor  is  triturated  thoroughly  with 
chloral,  a  soft  mass  is  obtained.  The  prescription,  however, 
can  be  dispensed,  but  care  must  be  taken  not  to  triturate  the 
(monobromated  camphor  and  the  chloral  too  strongly. 

304.  Carbo  Anim 3  i 

Tr.  Nuc.  Vom §  ss 

Tr.  Cinchon.  Comp 3  ij 

Tr.  Zingiberis 5  i 

Aquae,  ad 3  v™. 

S. :    3  ss  t.i.d.  p.  c. 

Charcoal  is  supposed  to  precipitate  alkaloids.  Still  the 
prescription  may  be  dispensed  and  if  well  shaken  there  is 
little  danger.  It  is  not  a  pleasant  mixture  to  take,  but  some 
physicians,  and  some  patients,  too,  still  think  that  the  nastier 
a  medicine  tastes,  the  more  efficient  it  must  be. 

305.  Chloral  Hydrati 

Camphorae aa  3  ss 

S.:     For  external  use  only. 

When  chloral  and  camphor  are  triturated  together  they 
form  a  clear  liquid  and  the  pharmacist  should  be  careful  not 
to  dispense  the  prescription  except  in  the  form  of  a  clear 
liquid.  This  injunction  may  seem  superfluous,  but  for  the 
fact  that  the  writer  only  recently  saw  a  druggist  dispense 
the  above  prescription  in  a  box  in  the  form  of  a  powder.  He 
powdered  the  camphor  all  right,  then  powdered  the  chloral 
separately,  mixed  the  two  and  put  them  in  a  box.  Naturally 
a  sticky  mass  was  the  result,  which  was  entirely  different  from 
what  the  physician  expected. 

On  the  other  hand  the  writer  knows  of  a  case  where  the 
physician  was  both  surprised  and  indignant  when  the  above 
prescription  was  delivered  in  a  bottle  as  a  liquid.  He  was 


158          PRESCRIPTION  INCOMPATIBILITIES 

sure  that  a  mistake  had  been  made  because  he  was  under  the 
impression  that  he  would  get  a  powder,  which  was  to  be 
sprinkled  over  an  ulcer. 

306.  Chloral 

Camphor aa  3  iij 

Phenol    3  i 

S. :    Apply  externally. 

The  remarks  of  the  previous  prescription  apply  to  this  one 
as  well.  It  might  be  added  that  the  pure  crystallized  and 
not  the  liquefied  phenol  should  be  used. 

307.  Chloretone  3  i 

Menthol   gr.  x 

Ac.  Borici  3  ss 

M.f.  pulv.    For  external  use. 

When  equal  parts  of  chloretone  and  menthol  are  rubbed 
together  a  liquid  is  obtained.  In  this  case,  however,  the  pre- 
scription may  be  dispensed  because  it  contains  only  10  grains 
of  menthol.  The  proper  way  would  be  to  rub  the  chloretone 
with  half  the  boric  acid,  the  menthol  with  the  other  half 
and  then  mix  the  two  powders. 

308.  Hydrarg.   Bichlor 1:5000    ] 

Chinosol    1:1000    JW 250'° 

S.:    For  external  use. 

Chinosol  is  incompatible  with  mercuric  chloride  and  while 
both  are  excellent  antiseptics  the  two  should  never  be  pre- 
scribed together. 

309.  Potass.   Chloratis   3  ij 

Sodii  Thiosulph 3  i 

Glycerin!    §  ss 

Aquae  ad  3  vi 

S.:    3  i  four  times  a  day  internally;  also  to  be  used  mixed 
with  water  as  a  gargle. 

In  an  acid  solution  sodium  thiosulphate  reduces  chlorates 
with  the  liberation  of  chlorine  and  hydrochloric  acid.  This 


PRESCRIPTION  INCOMPATIBILITIES          159 

prescription,  however,  may  be  dispensed,  only  care  should 
be  taken  not  to  triturate  the  sodium  thiosulphate  with  the 
potassium  chlorate,  as  a  little  explosion  might  perhaps  result. 

310.  Potassii  Chloratis  gr.  iij 

Hydrarg.  Chlor.  Mitis gr.  i 

Sacchari gr.  v 

M.f.  pulv.  No.  1.    Tal.  Dos.  xij. 

S. :     One  4  times  a  day. 

One  druggist,  who  was  also  a  physician,  refused  to  dispense 
this  prescription  because  he  was  taught  or  he  had  read  or 
thought  he  had  read  somewhere  that  potassium  chlorate  will 
oxidize  calomel  to  mercuric  chloride.  There  is  no  foundation 
for  this  alleged  fact  and  the  prescription  may  be  dispensed. 

311.  Potassii  Chloratis 3  ij 

Hydrarg.  Chlor.  Miti 3  i 

Bism.   Subnitr 3  i 

M.  f.  pulv.    For  external  use. 

The  samp  may  be  said  about  this  prescription.  It  may  be 
dispensed  \vithout  any  apprehension.  The  potassium  chlorate 
should  be  powdered  separately,  or  should  be  used  in  fine  pow- 
der and  the  three  powders  should  be  mixed  lightly. 

312.  Magnesii  Sulph 3  i 

Aquae  Crotonis  %  iv 

S.:     §  ss  every  hour. 

This  prescription  is  presented  here  for  its  "funniness" 
and  the  writer  can  vouch  for  the  fact  because  he  witnessed 
it  himself.  The  prescription  was  presented  to  the  boss,  who 
handed  it  to  the  clerk,  a  very  excellent  prescriptionist,  but 
not  long  in  this  country.  He  weighed  out  one  ounce  of  mag- 
nesium sulphate,  then  went  to  the  poison  closet,  took  the 
croton  oil,  put  eight  drops  in  a  mortar,  put  some  magnesium 
carbonate  in  the  mortar  and  began  to  add  the  water  grad- 
ually, triturating  briskly  and  getting  ready  to  filter  the  mix- 
ture. When  the  boss  asked  him  what  he  was  doing,  he  said 
he  was  preparing  Croton  water,  and  he  was  used  to  preparing 


160          PRESCRIPTION  INCOMPATIBILITIES 

''waters"  extemporaneously  by  rubbing  up  two  drops  of  the 
oil  with  an  ounce  of  water.  He  did  not  know  the  expression 
"Croton  water"  which  simply  referred  to  New  York  tap 
water.  He  thought  the  physician  wanted  a  "croton  oil" 
water.  He  felt  strengthened  in  his  assumption  by  the  fact 
that  the  prescription  was  meant  as  a  cathartic  and  there 
was  nothing  more  plausible  than  to  have  some  croton  oil  and 
magnesium  sulphate  in  the  same  mixture. 

•  313.    Barii  Sulph 3  " 

S. :    For  doctor's  use. 

There  is  no  better  illustration  of  the  necessity  for  physi- 
cians writing  out  a  prescription  clearly,  distinctly  and  fully 
wherever  there  may  be  the  slightest  possibility  of  misunder- 
standing, than  the  above  prescription.  It  also  shows  the  im- 
portance for  a  druggist  to  be  up  to  date,  to  know  what  is 
going  on  in  the  line  of  materia  medica  and  therapeutics,  to 
be  fully  au  courant  with  what  physicians  are  apt  to  pre- 
scribe. The  above  simple  prescription  of  just  one  line  cost 
a  man  his  life,  caused  the  arrest  of  two  physicians  and  of  the 
druggist,  and  an  endless  amount  of  anxiety  and  expense  to 
all  three,  besides  the  anguish  and  the  suffering  of  the  family 
of  the  dead  man. 

Druggists  have  for  many  years  been  dispensing  barium 
sulphide,  which,  as  is  well  known,  is  used  as  a  depilatory  to 
remove  superfluous  hair.  The  druggist  who  received  the 
above  prescription  did  not  know  that  of  late  we  have  been 
using  very  frequently  barium  sulphate  (instead  of  bismuth 
subnitrate)  in  taking  x-ray  pictures  of  the  gastro-intestinal 
canal.  So  when  the  druggist  received  the  above  prescription 
he  promptly  dispensed  two  ounces  of  barium  sulphide.  On 
receiving  the  bottle  the  physician  emptied  it,  mixed  it  with 
the  proper  amount  of  water  and  made  the  patient  drink  it. 
The  patient  very  soon  began  to  feel  badly  and  in  an  hour  he 
was  dead  in  spite  of  all  that  was  done  to  save  him. 


PRESCRIPTION  INCOMPATIBILITIES          161 

Now,  barium  sulphate  is  harmless  because  it  is  insoluble 
in  the  stomach  and  intestines,  is  not  absorbed  by  the  system 
and  is  passed  out  with  the  feces.  Barium  sulphide  is  poison- 
ous and  is  not  to  be  used  internally  except  in  very  small 
doses. 

314.    Calcil  Chloridi   3  j 

Pulv.  Cretae  Compos 3  iij 

Aquae   q.s.  ad  §  ij 

S. :    3  i  every  2  hours. 

The  above  prescription  very  nearly  cost  a  little  baby  its 
life.  Here  there  was  no  excuse  for  the  druggist — it  was 
plain  ignorance.  It  was  plainly  written  as  above,  calcii 
chloridi.  But  the  drug  clerk  had  never  dispensed  calcium 
chloride.  He  knew  calx  chlorinata  and  he  took  a  dram  of 
that  and  put  it  in  the  prescription.  The  baby,  who  was  suf- 
fering with  a  severe  bloody  diarrhea,  began  to  choke,  became 
blue  in  the  face,  and  it  looked  as  if  it  would  strangle  any 
moment.  Fortunately,  however,  after  a  severe  attack  of 
vomiting,  it  began  to  feel  better.  The  mother  ran  to  the 
druggist  with  the  bottle  and  asked  him  if  a  mistake  had  not 
been  made.  He  of  course  said  no,  bu.t  by  a  lucky  accident 
the  physician  had  just  come  into  the  store  and  hearing  what 
the  trouble  was  asked  to  look  at  the  bottle.  He  smelled  it 
and  noticed  a  strong  odor  of  chlorine,  and  then  he  told  the 
druggist  on  the  quiet  behind  the  prescription  counter  that 
there  must  be  some  mistake,  that  calcium  chloride  has  no 
odor  of  chlorine,  that  he  prescribed  it  a  number  of  times, 
and  while  it  has  not  a  pleasant  taste  it  will  not  make  any 
child  choke  and  get  cyanotic.  With  the  help  of  the  doctor 
the  matter  was  straightened  out  and  the  child  was  not  any 
the  worse  for  it.  In  fact  it  seemed  to  make  very  favorable 
progress  after  that.  It  is  possible  that  the  chlorinated  lime 
had  a  good  disinfectant  effect  on  the  gastro-intestinal  canal, 
but  the  infant  could  have  lost  its  life. 


162          PRESCRIPTION  INCOMPATIBILITIES 

315.  Collodii 

Tr.  lodi  .................................  aa  3  ij 

There  is  nothing  wrong  with  this  prescription.  It  may  be 
dispensed  as  written. 

316.  Heroini    ..................................  gr.  iv 

Ammon.  Carbon  ...........................      3  ij 

Syr.  Pruni  Virgin  ..........................     3  i 

Aquae  ..................................  ad    3  "j 

S.:    3  i  q.  3  hours. 

When  heroin  is  prescribed  without  any  specification,  heroin 
hydrochloride  is  usually  dispensed.  Heroin  being  an  alka- 
loid will  be  precipitated  by  the  ammonium  carbonate  and  by 
the  tannic  acid  of  the  syrup  of  wild  cherry.  Still  I  have 
seen  it  dispensed  many  times  without  any  trouble,  only  it 
is  safer  to  dispense  it  with  a  shake  label. 


317.  Adrenalin 

Aquro  Hydrogenii  Dioxidi 
S.:     For  external  use. 

This  prescription  is  absolutely  incompatible  and  should  not 
be  dispensed.  The  adrenalin  is  completely  decomposed  or 
oxidized  by  the  hydrogen  dioxide. 

The  physician  writes  for  one-half  ounce  of  "adrenalin." 
What  he  means  of  course  is  one-half  ounce  of  the  solution  of 
adrenalin  chloride  1  to  1000.  It  would  be  a  mighty  expensive 
prescription  if  it  were  to  contain  one-half  ounce  of  pure 
adrenalin. 

318.  Sol.  Epinephrini  ..........................      3  i  j 

Hydrarg.  Chlor.  Corros  .....................     gr.  i 

Aq.  Destill  ................................      3  vi 

Use  as  injection. 

Absolutely  incompatible.  The  epinephrin  is  decomposed 
and  the  mercuric  chloride  is  reduced  to  calomel  and  then  to 
the  metallic  state. 


PRESCRIPTION  INCOMPATIBILITIES          163 

319.  Exalgin   gr.  v 

Phenacetin gr.  v 

M.f.  pulv.  No.  1.    D.  T.  D.  xij. 

S.:     One  powder  when  required. 

When  exalgin  is  triturated  with  phenacetin  a  moist  or  a 
soft  mass  is  obtained.  The  prescription  cannot  well  be  dis- 
pensed in  powder  form.  It  can  be  dispensed  by  putting  the 
exalgin  and  the  phenacetin  in  separate  powders  and  directing 
the  patient  to  take  one  of  each  powders  at  a  dose.  It  can 
also  be  dispensed  in  capsules  by  putting  five  grains  of  each 
of  the  ingredients  in  a  capsule  without  any  mixing  or  tritura- 
tion. 

320.  Exalgini 

Phenacetini    aa  gr.  iii 

Sodii  Salicyl. 

Ac.  Salicyl aa  gr.  v 

M.  pulv.    Tal.  Dos.  xxx. 
One  3  times  a  day. 

The  first  two  ingredients  in  this  prescription  are  the  same 
as  in  the  previous  one  and  the  same  remarks  hold  good.  We 
could  make  one  powder  containing  the  phenacetin,  sodium 
salicylate  and  the  salicylic  acid,  another  powder  containing  the 
exalgin,  and  direct  the  patient  to  take  one  powder  of  each 
kind. 

321.  Creosoti  3  i 

Guaiacol 3  iij 

M.f.  pil.  No.  xxx. 

S.:     One  pill  four  times  a  day. 

It  simply  cannot  be  done.  It  is  no  use  attempting  to  make 
pills  containing  two  minims  of  creosote  and  six  minims  of 
guaiacol.  The  writer  is  well  aware  of  the  various  maneuvers 
and  excipients  employed  to  make  creosote  and  guaiacol  pills. 
In  fact  he  himself  used  to  be  an  expert  in  this  field  and  as 
a  pharmacist  was  very  proud  of  his  ability  to  turn  out  in 
quick  order  two,  three  or  five  hundred  creosote  pills.  By 


164          PRESCRIPTION  INCOMPATIBILITIES 

using  a  little  yellow  wax,  melted  of  course,  also  some  pow- 
dered licorice  or  magnesia,  etc.,  some  sort  of  pills  can  be 
made.  But  all  this  is  nothing  but  a  waste  of  time  and  energy 
— it  is  a  sho wing-off  of  useless  virtuosity.  It  is  the  writer's 
opinion,  his  opinion  as  a  physician  and  not  a  pharmacist, 
that  no  decent  creosote  pills  can  be  made  that  would  do  the 
patient  any  good.  Made  in  the  form  of  pills  the  quantity  of 
the  creosote  must  be  so  small  as  to  be  hardly  of  any  value, 
and  if  made  to  contain  a  considerable  amount  of  creosote 
with  very  little  excipient,  the  effect  is  apt  to  prove  irritating 
and  caustic.  The  proper  way  to  administer  creosote  is  in  liq- 
uid form,  properly  diluted,  or  in  the  form  of  some  of  its 
chemical  combinations.  It  would  be  a  very  fair  and  honest 
thing  to  enlighten  the  physician  on  this  point,  so  that  he  may 
be  discouraged  in  the  future  from  ordering  creosote  or 
guaiacol  in  pill  form. 
322.  Creosote 

Guaiacol 

Creosotal 

Duotal 

Thiocol  aa  gr.  v 

M.  pulv.    Tal.  Dos.  200 

S. :  One  powder  night  and  morning  and  after  each  meal. 
Of  course  this  is  a  ridiculous  prescription.  The  physician 
was  very  anxious  to  cure  his  patient  and  to  give  him  at  once 
all  the  anti-tuberculosis  remedies  that  he  had  heard  of.  But 
he  overlooked  the  fact,  or  perhaps  he  didn't  know  it,  that 
creosote  and  guaiacol  and  creosotal  are  liquids  and  cannot 
be  dispensed  in  powder  form.  Duotal,  or  guaiacol  carbonate, 
and  thiocol,  potassium  guaiacol  sulphonate,  are  crystalline 
substances  and  can  be  dispensed  in  powders.  There  are  no 
two  ways  about  this  prescription — the  only  thing  the  drug- 
gist can  do  is  to  notify  the  physician  and  advise  him  to  dis- 
pense the  first  three  ingredients  in  liquid  form  and  the 
second  two  in  powder  form  or  to  dispense  them  all  in  a  liq- 
uid mixture. 


PRESCRIPTION  INCOMPATIBILITIES          165 

323.  Mass.  Ferri   Carbon gr.  v 

Ac.  Salicyl gr.  iij 

MX  pil.  No.  1.    Tal.  Dos.  XL. 

One  ter  in  die  p.  c. 

These  pills  are  likely  to  burst  open.  The  salicylic  acid  de- 
composes the  ferrous  carbonate  with  the  liberation  of  carbon 
dioxide,  which  gradually  breaks  up  the  pill. 

324.  Ferri    Carbon 

Sodii  Carbon aa  gr.  v 

M.  pil.  No.  1.    Tal.  Dos.  No.  C. 
S.:    One  t.i.d. 

Ferrous  sulphate  and  sodium  carbonate  are  often  prescribed 
to  make  fresh  ferrous  carbonate.  The  writer  is  strongly  of 
the  opinion  that  what  the  physician  intended  to  write  was 
ferrous  sulphate.  If  he  really  meant  ferrous  carbonate,  then 
there  is  no  reason  for  having  the  sodium  carbonate  in.  Of 
course  the  prescription  can  be  dispensed,  but  in  the  writer's 
opinion  it  would  be  a  kindness  both  to  the  physician  and  the 
patient  to  communicate  with  the  former  so  as  to  make  sure 
whether  that  is  what  he  wanted. 

325.  Strych.  Sulph gr.  i 

Quin.  Sulph gr.  xxx 

Sodii  Glycerophosph 5  iss 

MX  pil.  No.  1.    TaL  Dos.  XXX. 

First  of  all  you  will  notice  the  physician  has  made  a  mis- 
take in  the  directions.  He  writes  tales  doses,  that  is,  he 
wants  each  pill  to  contain  one  grain  of  strychnine,  30  grains 
of  quinine  and  l1/^  drams  of  sodium  glycerophosphate.  What 
he  meant  of  course  was  to  divide  into  thirty  pills.  Then  each 
pill  would  contain  1-30  of  a  grain  of  strychnine,  1  grain  of 
quinine  and  three  grains  of  sodium  glycerophosphate,  which 
is  quite  proper.  But  even  with  that  correction,  the  prescrip- 
tion is  not  a  very  good  one,  because  it  is  pretty  difficult  to 
make  satisfactory  pills  which  should  contain  three  grains  of 
sodium  glycerophosphate.  But  with  a  little  magnesia,  licorice 


166          PRESCRIPTION  INCOMPATIBILITIES 

or  althea,  it  can  be  managed.  The  pills,  however,  would  be 
too  large,  and  it  would  not  be  a  bad  idea  to  inquire  of  the 
physician  if  he  would  not  prefer  to  substitute  calcium 
glycerophosphate  for  the  sodium  glycerophosphate. 

326.  Guaiacolis  Crystall 15.0 

Div.  in  pil.    No.  L. 

Two  pills  three  times  a  day. 

There  is  a  pure  crystallized  guaiacol  which  can  be  made 
into  pills,  but  it  readily  deliquesces  and  it  is  best  to  pre- 
scribe guaiacol,  as  stated  in  a  previous  prescription,  in  liquid 
form. 

327.  Hydrarg.  Ammon 3  i 

Sulphuris  3  ij 

Potassii  Carbon 3  ss 

Adipis 3  i 

For  external  use. 

When  made  up  this  ointment  is  yellowish  white.  But  after 
a  while  it  gets  darker  until  it  becomes  gray  or  black.  There 
is  a  reaction  between  the  sulphur  and  the  potassium  carbonate 
and  the  ammoniated  mercury,  by  which  some  sulphide  of 
mercury  and  the  black  mercur-ammonium  chloride  is  formed. 

328.  Hydrarg.  Chlor.  Corros gr.  iv 

Potassii  lodidi  5  iv 

Aquae 3  v* 

S. :    3  i  4  x  a  day. 

Of  course  this  prescription  is  all  right.  It  is  one  of  the 
commonest  prescriptions  that  a  druggist  has  to  dispense. 
Nevertheless,  strictly  speaking,  it  is  incompatible  because 
mercuric  iodide  is  formed  which  redissolves  in  an  excess  of 
potassium  iodide,  forming  the  double  iodide  of  potassium  and 
mercury,  the  so-called  iodohydrargyrate  of  potassium  or 
Mayer's  reagent,  which  is  such  an  excellent  precipitant  of 
alkaloids. 

I  know  of  a  case  of  a  junior  clerk  who  refused  to  dispense 
this  prescription.  When  he  mixed  the  mercuric  chloride 


PRESCRIPTION  INCOMPATIBILITIES          167 

and  the  potassium  iodide  and  noticed  the  formation  of  a  red 
precipitate,  he  being  a  careful  young  fellow,  was  afraid  to 
dispense  it.  He  waited  until  the  senior  clerk  came  in,  who 
explained  to  him  that  the  precipitation  was  all  right. 

329.  Hydrargyri  Chlor.  Cor 3  i j 

Potassii  lodidi gr.  ij 

Syr.  Sarsap.  Comp $  iij 

Aquae 5  i 

S. :    Teaspoon  3  times  a  day. 

An  experienced  druggist  will  have  no  difficulty  with  this 
prescription.  He  will  notice  at  once  that  the  doctor  absent- 
mindedly  turned  the  quantities  of  the  two  principal  ingredi- 
ents around.  Pie  meant  two  grains  of  mercuric  chloride  and 
two  drams  of  potassium  iodide,  but  instead  he  wrote  two 
drams  of  mercuric  chloride  and  two  grains  of  potassium 
iodide.  Of  course,  made  up  the  way  the  prescription  is  writ- 
ten, a  teaspoonful  of  the  medicine  would  kill  the  patient.  I 
am  personally  of  the  opinion  that  he  made  the  same  mistake 
with  the  syrup  and  water,  that  he  really  meant  one  ounce 
of  syrup  and  three  ounces  of  water.  But  as  it  is  of  little  con- 
sequence whether  one  ounce  or  three  ounces  of  compound 
syrup  of  sarsaparilla  is  dispensed,  the  quantities  of  the  last 
two  ingredients  may  be  dispensed  as  written. 

330.  Hydrarg.  Bichlor gr.  i 

Liq.   Fowleri    $  ss 

S. :     gtt.  viii  in  water  after  meals. 

This  prescription  is  incompatible.  The  mercuric  chloride 
is  reduced  to  calomel  and  to  metallic  mercury,  while  the 
arsenite  is  changed  into  arsenate.  The  prescription  is  in- 
compatible and  should  not  be  dispensed. 

331.  Hydrargyri  Chlor.  Corros gr.  iv 

Aquae  Calcis  %  iv 

S. :     For  external  use. 
This  prescription,  while  chemically  speaking  incompatible, 


168          PRESCRIPTION  INCOMPATIBILITIES 

is  all  right.     It  forms  the  well-known  yellow  wash    (Lotio 
Flava).    When  lime  water  is  added  to  mercuric  chloride  the 
yellow  mercuric  oxide  is  formed.    The  reaction  is  as  follows : 
HgCl2  -f  Ca(OH)2  =  CaCl2  +  HgO  -f  ILO 

332.  Hydrargyri  Chlor.  Corros 3  ss 

Aquae  Calcis I  viij 

S.:    Poison.    For  external  use. 

In  this  prescription  we  also  get  a  precipitate  of  the  yellow 
oxide  of  mercury.  But  the  prescription  contains  too  much 
mercuric  chloride  and  if  it  is  to  be  applied  to  an  infant,  to 
a  delicate  surface,  or  to  a  raw  surface,  it  should  be  done  with 
great  caution  as  great  irritation  of  the  skin  may  occur,  or 
even  an  absorption  of  mercuric  chloride,  which  may  cause 
dangerous  or  toxic  symptoms. 

333.  Hydrargyri  Chlor.  Mitis    3  ss 

Aquae  Calcis  3  v* 

S. :    Apply  externally  every  hour. 

This  forms  the  well-known  black  wash  which  is  a  favorite 
application  to  chancroids,  phagedenic  ulcers  and  so  forth. 
When  calomel  is  added  to  lime  water  the  black  mercurous 
oxide  is  formed.  The  formula  is  as  follows: 

2HgCl  -f  Ca(OH)2  =  CaCl2  +  Hg20  -f  H20 

334.  Ung.  lodi 3  ij 

Ung.  Belladon 3  vi 

Hydrarg.  Chlor.  Mit gr.  xx 

M.f.  Ung.— S.  Pile  Ointment. 

It  is  not  advisable  to  prescribe  iodine  (elementary  iodine) 
and  mercurial  salts  in  the  same  prescription.  Red  mercuric 
iodide  is  apt  to  form,  which  is  very  irritating.  Calomel  in 
ointment  form  acts  well  in  hemorrhoids.  But  red  mercuric 
iodide  even  in  very  dilute  preparations  is  painful  and  irri- 
tating, as  it  has  proved  in  this  case, 


PRESCRIPTION  INCOMPATIBILITIES          169 

335.  Hydrargyri  Salicyl 10.0 

Aqu.  Destill 100.0 

S.:     Hg.  Salicyl.  10%. 

Salicylate  of  mercury  is  insoluble  in  water,  but  is  soluble 
in  the  halogen  compounds  of  the  alkalies,  such  as  potassium 
chloride,  sodium  chloride,  etc.  The  best  way  to  make  up  this 
prescription  is  to  dissolve  the  salicylate  of  mercury  in  100  c.  c. 
of  a  normal  salt  solution,  i.  e.,  7-10  per  cent,  solution  of  chem- 
ically pure  sodium  chloride. 

336.  Fluidext.   Hyoscyami    3  ij 

Potassii  Bicarbon 3  iij 

Fluidext.  Tritici  3  iv 

Fluidext.  Buchu   3  ij 

Aquae  ad  3  iij 

The  pharmacist  or  physician  who  has  learned  that  alka- 
loids must  not  be  prescribed  with  alkalies  might  be  afraid 
to  write  or  dispense  the  above  prescription,  thinking  that  the 
potassium  bicarbonate  would  precipitate  the  alkaloids  of 
hyoscyamus.  But  it  so  happens  that  the  alkaloids  of  hyo- 
scyamus,  i.  e.,  hyoscyamine  and  hyoscine,  are  not  precipitated 
by  alkalies,  and  so  the  above  prescription  may  be  safely  dis- 
pensed. It  is  a  very  common  and  useful  prescription  'in 
cystitis. 

337.  Ichthyol 3  i 

Zinci  Sulph gr.  xviij 

Aquae 3  ™ 

S. :     Inject  3  times  a  day. 

This  prescription  is  absolutely  incompatible  and  cannot 
and  must  not  be  dispensed.  An  unsightly  precipitate  is 
formed  from  the  combination  of  the  ichthyol  with  the  zinc. 
The  physician  must  be  informed  so  that  he  may  change  the 
prescription  or  order  the  two  ingredients  in  different  injec- 
tions, 


170          PRESCRIPTION  INCOMPATIBILITIES 

338.  lodoformi  5  i 

Bals.  Peruvian! 3  ij 

Adipis  Benz 5  iss 

S. :    Apply  on  lint. 

Certain  statements  have  been  made  that  iodoform  is  in- 
compatible with  balsam  of  Peru.  There  is  no  foundation  for 
these  statements.  The  two  go  very  well  together  and  the 
prescription  is  perfectly  all  right. 

339.  Tr.  lodi 3  ij 

Aq.  Ammon 3  iv 

Linim.  Saponis $  iv 

S. :    For  external  use. 

The  iodine  will  combine  with  the  ammonia  to  form  ammo- 
nium iodide.  Where  there  is  sufficient  ammonia  to  combine 
with  the  entire  amount  of  iodine  the  color  of  the  iodine  will 
be  destroyed  and  the  preparation  will  be  colorless  because 
ammonium  iodide  is  colorless.  Whenever  iodine  is  brought 
into  direct  contact  with  ammonia,  there  is  also  slight  danger 
of  iodide  of  nitrogen  being  formed,  which  is  an  explosive 
compound.  But  in  small  quantities,  with  which  we  generally 
have  to  deal  in  prescriptions,  the  danger  is  more  a  theoret- 
ical than  a  practical  one. 

340.  Ung.  lodi 3  ij 

Ung.  Hydrargyri 3  vi 

M.f.  Ung.  S.    Apply  3  times  a  day. 

The  iodine  combines  with  the  metallic  mercury  and  with 
the  oxide  of  mercury  which  is  usually  present  in  the  mer- 
curial ointment  to  form  mercuric  iodide.  .  This  is  much  more 
irritating  than  either  iodine  ointment  or  the  mercurial  oint- 
ment itself.  As  this  prescription  is  often  ordered  for  epi- 
didymitis  and  orchitis,  and  as  the  skin  of  the  scrotum  is  very 
tender,  it,  i.  e.,  the  skin;  is  often  completely  removed  by  this 
ointment.  It  also  burns  very  severely  in  some  cases.  If  it 
does,  the  only  thing  to  do  is  to  wash  it  off  with  soap  and 
warm  water  and  then  apply  an  emollient  ointment  like  cold 


PRESCRIPTION  INCOMPATIBILITIES          171 

cream  or  zinc  oxide  ointment,  or  some  talcum  powder  or  bis- 
muth subnitrate. 

341.  Liq.  Formaldehydi 

Liq.  Hydrogenii  Diox aa  3  viij 

S.:     Use  externally  as  directed. 

This  prescription  is  absolutely  incompatible.  The  formal- 
dehyde is  oxidized  by  the  peroxide  of  hydrogen  to  formic 
acid,  and  the  H202  is  decomposed.  An  example  of  trying  to 
get  too  much  and  of  getting  nothing. 

342.  Lithii  Citratis  3  ij 

Sodii  Phosphatis „ 3  ij 

Aquae 3  *v 

S. :     3  ij  in  glass  of  water  night  and  morning. 

In  this  prescription  we  get  a  precipitate  of  lithium  phos- 
phate. Of  course  it  may  be  dispensed  with  a  shake  label. 

343.  Magn.  Sulphatis 

Sodii  Phosphatis   aa  3  *v 

S. :     3  ij  in  glass  of  water  on  going  to  bed. 

Here  we  get  a  precipitate  of  magnesium  phosphate.  It 
would  be  much  better  to  dispense  the  magnesium  sulphate 
and  the  sodium  phosphate  in  separate  containers,  and  tell  the 
patient  to  take  a  spoonful  of  each  in  half  a  glass  of  water, 
and  drink  them  separately.  It  is  better  the  reaction  should 
take  place  in  the  stomach  than  in  the  glass. 

344.  Menthol  3  i 

Alcohol  3  i 

Aquae 3  *v 

S.:     Apply  externally. 

The  menthol  dissolves  rapidly  in  the  alcohol,  but  on  adding 
the  water  it  precipitates.  We  get  a  cloudy  mixture  with 
the  menthol  precipitated  out.  Incompatible  prescription, 
which,  honestly  speaking,  should  not  be  dispensed. 


172         PRESCRIPTION  INCOMPATIBILITIES 

345.  Tr.  Ferri  Chloridi %i 

Methyl   Salicyl gtt.  x 

S.:    gtt.  x  in  water  after  meals. 

Here  one  can  see  that  the  methyl  salicylate  has  been  pre- 
scribed for  the  express  purpose  of  disguising  the  color  of 
the  tincture  of  iron.  One-twenty-fourth  of  a  drop  of  methyl 
salicylate  (which  is  the  dose  in  this  case)  can  have  no  me- 
dicinal action.  But  as  patients  are  familiar  with  ordinary 
tincture  of  iron  and  are  apt  to  sneer  at  it,  physicians  often 
disguise  its  color  either  with  a  little  antipyrine  or  sodium 
salicylate  or  any  other  salicylate. 

346.  01.  Olivae   3  ij 

Menthol 3  i 

Glycerin   3  ij 

S. :    For  external  use. 

Menthol  is  very  soluble  in  olive  oil  as  in  all  fixed  or  volatile 
oils.  But  the  oil  is  not  miscible  with  glycerin,  contrary  to 
the  impression  of  many  physicians.  As  stated  elsewhere, 
many  people,  both  lay  and  professional,  regard  glycerin  in 
the  nature  of  a  fat  and  think  it  must  be  miscible  with  other 
fats.  But  it  is  not.  This  prescription  does  not  make  a  very 
elegant  mixture,  but  may  be  dispensed  with  a  shake  label. 

347.  Menthol   gr.  x 

Petrolati  liq 3  i 

Glycerin §  i 

S. :    Use  with  atomizer. 

The  remarks  of  the  previous  prescription  apply  to  this  one 
as  well.  Menthol  is  very  soluble  in  liquid  petrolatum,  but 
liquid  petrolatum  is  not  soluble  in  or  miscible  with  glycerin. 

348.  Pepsini  3  ij 

Pancreatini 3  ij 

Ac.  Hydrochlor.  dil 3  iv 

Syr.  Zingib 3  i 

Aquae ad  3  iv 

S.:    3  i  after  meals. 
Pancreatin  is  considered  to  be  absolutely  incompatible  with 


PRESCRIPTION  INCOMPATIBILITIES          173 

hydrochloric  acid  or  any  other  acids.  Its  activity  is  sup- 
posed to  be  destroyed.  Pancreatin  and  pepsin  in  the  same 
mixture  are  also  supposed  to  be  incompatible.  But  neverthe- 
less many  physicians  are  prescribing  this  combir  *on,  claim- 
ing they  get  good  results  from  it  and  the  pharmacist  has  no 
choice  but  to  dispense  it. 

349.  Piperazinae     25.0 

Div.  in  pulv No.  25 

S.:     One  powder  in  glass  of  water  5  times  a  day. 
Piperazine   is  sometime   quite  hygroscopic   and  it  is  not 
advisable  to  dispense  it  in  powder  form.     The  proper  way 
to  dispense  it  is  in  solution. 

350.  Cocainae  Hydrochlor 0.6 

Morphin.  Sulph 0.3 

Atropin.  Sulph 0.02 

Petrolati  Albi 25.0 

M.f.  Ung.    Apply  after  each  defecation. 

The  alkaloidal  salts  may  be  dissolved  in  a  very  small  quan- 
tity of  water  and  the  solution  incorporated  with  the  white 
petrolatum.  It  would  be  still  better  if  the  physician  had  pre- 
scribed the  pure  alkaloids,  because  the  pure  alkaloids  are  as 
a  rule  soluble  in  solid  or  liquid  petrolatum,  while  their  salts 
are  not. 

351.  Phenol  gtt.  xv 

Arg.  Nitr. gr.  v 

Aquae 5  v 

S. :    For  external  use. 

The  prescription  is  incompatible.  The  silver  nitrate  is  re- 
duced to  silver  oxide  and  metallic  silver. 

352.  Salol gr.  v 

Camphor  gr.  ij 

Antipyrin   gr.  iij 

M.f.  pulv.  No.  1.    Tal.  Dos.  XL. 

This  is  a  well  known  incompatibility.  A  soft  mass  or  a 
moist  powder  is  the  result. 


174          PRESCRIPTION  INCOMPATIBILITIES 

353.  Protargol   gr.  xx 

Plumbi  Acet gr.  xij 

Argenti  Nitratis   gr.  v 

Aq.  Destill  I  v 

To  be  used  as  injection. 

Absolutely  incompatible.  Protargol  is  incompatible  both 
with  silver  nitrate  and  with  lead  acetate,  and  lead  acetate  is 
also  incompatible  with  silver  nitrate. 

354.  Pyramidon    3  i 

Spir.  Aetheris  Nitrosi 3  iv 

Syr.  Aurantii 3  i 

Aquae    ad    3  ij 

S. :     3  ij  every  4  hours. 

The  solution  acquires  a  blue  or  violet  color.  What  we  said 
about  the  incompatibility  of  antipyrin  with  spirit  of  nitrous 
ether  applies  here  as  well.  The  compound  formed  may  not 
be  poisonous,  most  likely  is  not,  but  it  is  better  not  to  pre- 
scribe pyramidon  with  spirit  of  nitrous  ether. 

355.  Pyrogallol   25.0 

Potass.  Permang 75.0 

S. :     3  i  in  basin  of  hot  water  for  foot  bath. 
This  prescription  is  absolutely  incompatible.    The  pyrogal- 
lol  is  oxidized,  the  potassium  permanganate  is  reduced. 

356.  Resorciui 

Quinin.  Bisulph aa  0.2 

In  caps,  gelat.  No.  1.     Tal.  Dos.  xx. 

This  prescription  is  all  right.  There  is  no  objection  to 
dispensing  resorcin  and  quinine  bisulphate  in  capsules,  but 
the  prescription  would  be  incompatible  if  these  two  ingredi- 
ents were  ordered  to  be  dispensed  in  solution,  as  then  we 
would  get  a  precipitate. 

357.  Aluminis   3  *ij 

Sodii  Boratis 3  xyi 

M.  ft.  pulvis 
S. :    3  ss  in  2  quarts  of  water. 


PRESCRIPTION  INCOMPATIBILITIES          175 

When  powdered  alum  is  rubbed  with  borax  the  mixture 
becomes  moist  due  to  the  liberation  of  the  water  of  crystal- 
lization. By  mixing  them  gently  this  physical  change  may  be 
prevented.  The  powder  should  be  dispensed  not  in  a  paper 
box  but  in  a  wide-mouthed  stoppered  bottle.  The  really 
better  thing  would  be  to  order  the  exsiccated  alum  instead  of 
the  ordinary  powdered  alum. 

358.  Sodii  Perboratis  B  i 

Aquae    3  xij 

S. :    For  external  use. 

When  sodium  perborate  is  dissolved  in  water  a  chemical 
reaction  takes  place,  hydrogen  dioxide  and  sodium  meta- 
borate  being  formed.  The  prescription  may  be  dispensed, 
because  that  is  what  the  doctor  generally  wants — a  freshly 
prepared  solution  of  hydrogen  dioxide. 

359.  Sol.  Potass.  lod.  Satur %  i 

Sodii  Thiosulphatis   gr.  v 

S. :     gtt.  x  in  milk  t.i.d. 

This  prescription  is  seen  frequently.  The  small  quantity 
of  sodium  thiosulphate  has  no  medicinal  action.  It  is  added 
for  the  purpose  of  preventing  the  liberation  of  iodine.  A 
solution  of  potassium  iodide  if  kept  for  any  length  of  time 
sometimes  gets  brown,  due  to  the  setting  free  of  small  quan- 
tities of  iodine.  The  sodium  thiosulphate  combines  with  any 
free  iodine  that  may  be  present  in  the  solution  and  the  solu- 
tion thus  remains  perfectly  colorless.  It  is  for  the  same 
reason  that  we  sometimes  add  sodium  thiosulphate  to  potas- 
sium iodide  ointment. 

360.  Potassii  lodidi  5  i j 

Sodii  lodidi 3  iij 

Spir.  Aether.  Nitr.  3  vi 

Ess.  Pepsini §  i 

Aquae    ad  3  vi 

S. :     3  i  3  times  a  day. 
The  change  in  the  color  of  this  mixture  will  depend  a  good 


176          PRESCRIPTION  INCOMPATIBILITIES 

deal  upon  the  purity  of  the  iodides  and  the  spirit  of  nitrous 
ether.  As  a  rule  it  gets  brown  after  a  short  time,  due  to  the 
liberation  of  iodine  from  iodides  by  the  nitrous  ether. 

361.  Spir.  Ammon.  Arom %  ss 

Sodii  Brom 3  8S 

Syr.  Aurantii   3  ss 

Aquae   %  "J 

S.:    3  i  as  directed. 

This  mixture  becomes  milky-turbid,  for  two  reasons.  Both 
the  sodium  bromide  and  the  water  liberate  the  volatile  oils 
from  the  aromatic  spirit  of  ammonia. 

362.  Strychn.  Hydrochlor %  i 

Ac.  Hydrochlor.  Dil gr.  i 

Elix.   Peptenzyme    3  i 

Aquae ad  3  " j 

S. :    3  i  after  meals. 

This  prescription  is  all  right.  Hydrochloric  acid  is  said 
to  give  a  precipitate  with  strychnine  hydrochloride,  but  this 
is  true  only  of  the  strong  hydrochloric,  not  of  the  dilute  acid. 

363.  Trional     gr.  x 

Chloral.  Hydr gr.  x 

M.f.  pulv.  No.  i.    Tal.  Dos.  iii. 

S. :    One  as  required. 

Trional  and  chloral  hydrate  when  rubbed  together  form  a 
soft  mass. 

364.  Trional 
Sulphonal 

Urethane    aa  gr.  v 

For  one  powder.    Take  at  once. 

When  trional  and  sulphonal  and  urethane  are  rubbed  to- 
gether, there  is  also  a  soft  or  semi-liquid  mass.  As  the  pre- 
scription calls,  however,  for  one  powder,  to  be  taken  at  once, 
the  ingredients  may  be  put  in  wax  paper  without  being  mixed, 
and  if  taken  at  once  there  will  be  no  trouble. 


PRESCRIPTION  INCOMPATIBILITIES          177 

365.  Sulphonal gr.  xv 

Chloral.  Hydrat gr.  xx 

M.f.  pulv.  1.    Tal.  Dos.  vi. 

S. :     Give  one  every  hour  until  effective. 

When  sulphonal  and  hydrated  chloral  are  rubbed  together 
a  soft  or  moist  mass  is  obtained. 

366.  Agurin     15.0 

Spartein.  Sulph 2.0 

Strychnin.   Sulph 0.03 

Syrupi   30.0 

Aquae    200.0 

S.:     Tablespoonful  every  2  hours. 

Agurin,  which  is  theobromine  sodium  acetate,  is  incom- 
patible with  alkaloids,  which  it  generally  precipitates.  It  is 
also  improper  to  dispense  agurin  with  syrup  or  sugar.  They 
decompose  it.  The  dose  of  sparteine  in  this  prescription  is 
also  too  large,  practically  two  grains  to  the  dose.  "While  in 
emergencies  we  sometimes  have  to  give  very  large  doses  of 
this  alkaloid,  still  it  is  best  to  make  sure  that  the  physician 
meant  what  he  wrote. 

367.  Diuretini    3  i j 

Liquor.  Ferri  et  Amm.  Acet §  vi 

Aquae  Menthae  Piper 5  ij 

S. :     3  ss  4  times  a  day. 

This  prescription  will  acquire  a  violet  color.  Diuretin  is 
theobromine  sodium  salicylate,  and  salicylates,  we  know,  give 
a  deep  blue  color  with  ferric  salts. 

368.  Thymol    3  ij 

Camphorae    3  iv 

Ac.  Carbolici   3  i 

Ac.  Borici  3  iy 

S. :    M.f .  pulv.    S. :    Apply  externally. 

When  thymol,  camphor  and  carbolic  acid  are  rubbed  to- 
gether a  liquid  mass  is  obtained.  By  powdering  the  first  two 


178          PRESCRIPTION  INCOMPATIBILITIES 

ingredients  separately,  mixing  the  phenol  with  the  finely 
powdered  boric  acid  and  then  mixing  all  the  ingredients  a 
serviceable  powder  may  be  obtained. 

369.  Thymolis  lodidi  3  ij 

Amyli     3  i 

S.:    Apply  externally. 

It  is  stated  that  thymol  iodide  is  incompatible  with  starch. 
It  is  claimed  that  some  iodine  may  be  liberated  and  combine 
with  the  starch  to  form  iodide  of  starch.  There  is  nothing 
to  this  criticism.  First  of  all  there  is  no  liberation  of  iodine 
when  the  two  are  mixed,  but  even  if  there  were  no  harm 
would  be  done.  On  the  contrary  it  probably  would  be  advan- 
tageous. For  wherever  thymol  iodide  is  applicable,  so-called 
iodide  of  starch  is  also  applicable.  So  there  is  no  harm  in 
mixing  thymol  iodide  and  starch  together. 

370.  Thymol.  lodid. 

Calomel    aa  3  ij 

Apply  externally. 

When  kept  for  a  long  time,  or  thoroughly  triturated,  or 
in  the  presence  of  moisture,  red  mercuric  iodide  may  be 
formed ;  but  a  little  of  it  won 't  hurt.  I  have  personally  pre- 
scribed thymol  iodide  and  calomel  a  number  of  times  as  an 
application  to  chancroids  and  only  with  good  results. 

371.  Zinei  Sulph gr.  xij 

Ac.  Tannici  gr.  xij 

Aquae    3  vi 

S.:    Use  as  injection. 

This  prescription  is  all  right.  Generally  speaking,  tannic 
acid  is  incompatible  with  zinc  sulphate,  zinc  tannate  being 
precipitated.  But  this  occurs  only  when  the  two  chemicals 
are  in  concentrated  solution.  It  does  not  take  place  when 
the  chemicals  are  in  dilute  solution. 


PRESCRIPTION  INCOMPATIBILITIES          179 

372.  Potass.  Permang 3  gm. 

Thymol   5  gm. 

Alcohol    5     mils. 

Water  to  make 100     mils. 

Dissolve  thymol  in  alcohol,  permanganate  in  water 
and  mix  solutions. 

S. :     Tablespoonf ul  to  2  quarts  of  tepid  water  for  foot 
lotion. 

This  prescription  was  copied  from  a  pharmaceutical  jour- 
nal which  in  its  turn  had  copied  it  from  The  Prescriber.  The 
Prescriber  is  such  a  careful,  competent  journal  that  one  can- 
not help  being  surprised  at  seeing  this  prescription  recom- 
mended in  its  pages.  Potassium  permanganate  is  incom- 
patible with  thymol  and  also  incompatible  with  alcohol.  After 
standing  a  while  the  potassium  permanganate  becomes  com- 
pletely reduced  and  worthless.  The  quantities  are  copied  cor- 
rectly, just  as  they  appeared  in  the  pharmaceutical  journal. 
But  to  us  they  seem  ridiculously  small.  Perhaps  it  is  a  typo- 
graphical error  and  the  author  of  the  prescription  meant  3 
grams  of  potassium  permanganate  and  5  grams  of  thymol 
instead  of  3  decigrams  and  5  decigrams,  respectively. 

373.  Ac.  Salicylici  3  ij 

Ac.  Tannici 3  ij 

Aluminis   3  ij 

Kaolini    3  iy 

M.f.  pulv.     S.:    Foot  powder.    Shake  into  stockings 
every  morning. 

This  prescription,  as  I  happen  to  know,  was  prescribed  for 
a  very  bad  case  of  bromidrosis,  that  is,  offensive  sweating  of 
the  feet.  The  patient  was  told  to  put  on  every  day  a  clean 
pair  of  socks,  and  preferably  white  socks,  not  colored  ones. 
When  the  patient  took  off  his  socks  the  first  night  he  was 
surprised  and  somewhat  shocked  to  find  both  his  feet  and  his 
socks  dyed  an  inky  black.  The  doctor  was  also  surprised  be- 
cause he  expected  no  such  thing;  he  expected  the  powder  to 


180          PRESCRIPTION  INCOMPATIBILITIES 

be  practically  white  or  slightly  grayish  from  the  tannic  acid 
and  the  kaolin.  The  trouble  with  this  prescription  is  this: 
Kaolin  usually  contains  some  iron.  Alum  also  now  and  then 
contains  a  small  quantity  of  iron.  Salicylic  acid  with  iron 
as  you  know  gives  a  deep  violet  color,  while  tannic  acid  gives 
a  bluish  black  color.  To  make  the  reaction  complete  a  little 
water  is  generally  necessary,  which  was  furnished  by  the 
perspiration  of  the  feet.  The  powder  itself  also  very  soon 
acquired  a  black  color. 

374.  Tr.  Digitalis  3  ss 

Tr.  Strophanthi  3  8S 

Sparteinae  Sulph gr.  xij 

Strychn.  Sulph gr.  ij 

Aquae ad      3  iij 

S.:     Teaspoonful  4  times  a  day. 

This  prescription  presents  no  incompatibility,  either  phar- 
maceutical or  therapeutic.  On  the  contrary  from  a  thera- 
peutic point  of  view,  it  is  a  ' '  synergistic "  prescription,  that 
is,  all  the  drugs  act  as  cardiac  tonics.  But  that  is  just  the 
trouble  with  it.  The  dose  of  each  ingredient  separately,  ex- 
cept perhaps  of  the  sparteine,  is  not  excessive,  and  may  be 
administered  without  trouble.  But  the  sum  total  of  the 
amounts  of  these  drugs,  one  fortifying  the  other,  is  excessive, 
and  in  this  case  the  patient  nearly  died  from  one  dose.  It 
took  several  hours  before  he  was  brought  out  of  danger. 

375.  Antikamnia 
Antipyrin 
Phenacetin 
Acetanilid 

Phenalgin each  5  grs. 

Caffeine 2  grs. 

For  one  powder.    Make  a  dozen. 
For  neuralgia. 

This  prescription  was  given  to  a  woman  who  suffered  from 
extreme  neuralgia  and  she  came  pretty  nearly  being  rid  of. 


PRESCRIPTION  INCOMPATIBILITIES       i$i 

all  her  troubles  after  the  first  powder.  About  ten  minutes 
after  taking  the  powder  she  became  cyanotic,  the  people 
around  her  claimed  that  she  was  as  black  as  ink,  and  it  took 
considerable  stimulation  with  black  coffee,  brandy,  hot  bottles, 
etc.,  before  she  was  brought  around. 

376.  Sol.  Morphin.   Sulph 3  i 

S. :    3  i  as  directed. 

In  this  case,  of  which  I  have  personal  knowledge,  the  pa- 
tient came  very,  very  near  losing  his  life.  The  druggist  dis- 
pensed Magendie's  solution,  of  which  a  teaspoonful  was  ad- 
ministered to  the  patient.  Now  as  you  well  know,  or  perhaps 
not  so  well  at  the  present  time,  there  are  two  solutions  of 
morphine.  One  contains  only  a  grain  to  the  ounce,  while  the 
other  one,  that  is  Magendie's  solution,  contains  two  grains  to 
the  dram.  Of  the  old  U.  S.  P.  solution,  which  contains  one 
grain  of  morphine  sulphate  to  the  ounce  of  water,  a  teaspoon- 
ful, containing  one-eighth  of  a  grain  of  morphine,  is  the 
proper  dose.  But  of  Magendie's  solution,  the  proper  dose 
is  only  four  to  eight  minims,  equivalent  to  one-eighth  to  one- 
quarter  grain  of  morphine.  A  teaspoonful  contains  two 
grains,  which  is  of  course  a  fatal  dose.  It  took  a  whole  night 's 
work,  with  potassium  permanganate  washings  of  the  stom- 
ach, rectal  injections  of  strong  black  coffee,  etc.,  before  death 
was  forced  to  loosen  her  grip  on  the  patient.  It  might  be  of 
interest  to  add  that  the  patient,  who  was  a  very  sick  person, 
and  to  whom  the  morphine  was  prescribed  to  allay  the  pains 
of  ple.uro-pneumonia,  began  rapidly  to  improve  after  his 
strenuous  night  in  which  he  hovered  between  life  and  death 
for  several  hours. 

377.  Hydrargyri  Chlor gr.  ^4 

Sacch.  Lactis    gr.  v 

Pu\v.  No.  1.    Tal.  Dos.  vi. 

S.:     One  every  hour. 

The  outcome  in  this  prescription  unfortunately  was  not  so 
favorable  It  was  made  up  by  an  unregistered  drug  clerk 


182         PRESCRIPTION  INCOMPATIBILITIES 

who  was  very  green  in  the  business.  He  used  one-quarter  of 
a  grain  of  corrosive  sublimate  to  each  powder.  Now  what 
the  doctor  wanted  was  one-quarter  of  a  grain  of  calomel. 
Of  course  he  should  have  written  the  prescription  more  care- 
fully but  any  competent  druggist  would  know  what  to  dis- 
pense. One-quarter  of  a  grain  of  mercuric  chloride  is  not 
such  a  terribly  big  dose  and  may  be  given  to  adults  without 
trouble.  But  it  so  happened  that  in  this  case  the  patient  was 
a  newborn  infant,  only  about  two  weeks  old,  and  it  died  very 
promptly  after  the  first  powder.  The  druggist  was  arrested, 
it  cost  him  a  big  sum  of  money,  and  he  is  not  entirely  over 
his  troubles  yet. 

378.  Menthol  gr.  x 

Eucalyptol min.  xv 

Zinci  Sulph gr.  x 

Albolene  liq %  ij 

Use  with  atomizer. 

This  is  an  annoying  but  unfortunately  too  frequent  pre- 
scription. The  menthol  and  eucalyptol  dissolve  in  the  liquid 
albolene,  but  the  zinc  sulphate  does  not.  No  matter  how 
finely  you  may  powder  it  and  incorporate  it  with  the  albolene, 
you  cannot  use  it  properly  with  an  atomizer.  It  remains  at 
the  bottom.  The  doctor  should  be  notified  and  advised  to 
leave  out  the  zinc  sulphate  or  to  prescribe  it  separately  in 
an  aqueous  solution. 

379.  Menthol  gr.  v 

Sol.   Adrenalin!    ,  3  ij 

Pinoleum 3  vi 

S. :     Use  as  a  spray. 

The  menthol  dissolves  in  the  pinoleum,  but  the  solution  of 
adrenalin,  which  is  an  aqueous  solution,  does  not  mix.  The 
water  and  oil  do  not  mix  and  it  is  a  bad  prescription  to  be 
jdispensed  to  use  in  a  spray. 


PRESCRIPTION  INCOMPATIBILITIES  183 

380.  Hydrargyri   Chlor.    Corr gr.  ij 

Pyrogallol    gr.  xx 

Petrolati  5  i 

Adipis  Lanae    %  ss 

S.:     Apply  to  scalp. 

Pyrogallol  and  mercuric  chloride  are  incompatible.  Mer- 
curic chloride  is  reduced  and  the  pyrogallol  is  oxidized.  Ex- 
posing the  ointment  to  light  and  air  also  changes  its  color 
rapidly. 

381.  Cocaini  Mur 0.6 

Camphorae    2.0 

Chloral!  Hydrat 2.0 

Apply  to  neuralgic  spots. 

The  proper  way  to  dispense  this  prescription  is  to  use  the 
pure  alkaloidal  cocaine  instead  of  the  cocaine  hydrochloride. 
It  might  be  added  that  cocaine  applied  externally  to  the 
unbroken  skin  is  perfectly  useless,  because  it  is  not  absorbed. 
Cocaine  exerts  its  anesthetic  properties  only  on  mucous  mem- 
branes or  where  the  skin  is  abraded. 

382.  Tr.  lodi  3  i j 

Ext.   Goulardi    3  vi 

3  i  to  glass  of  water  for  external  use. 

We  get  here  a  yellow  precipitate  of  lead  iodide.  Strictly 
speaking,  the  prescription  should  not  be  dispensed,  but  as  it 
is  for  external  use,  and  is  not  going  to  do  any  harm,  it  may 
be  dispensed  with  a  shake  label. 

383.  Calx  Chlorin I  i 

Glycerin!    3  i 

Aquae    3  i 

Apply  full  strength. 

Chlorinated  lime  is  incompatible  with  glycerin.  By  mixing 
the  two  directly  an  explosion  may  occur.  A  complex  chem- 
ical reaction  takes  place  in  which  the  glycerin  becomes  oxi- 
dized by  the  chlorine  to  oxalic  and,  eventually,  carbonic  acid. 
By  rubbing  the  chlorinated  lime  with  the  water  into  a  smooth 


184          PRESCRIPTION  INCOMPATIBILITIES 

mixture  and  then  adding  the  glycerin,  the  violence  of  the 
reaction  is  lessened,  but  it  is  not  entirely  eliminated. 

384.  Massae  Valleti gr.  v 

Kali  Carbonici  gr.  v 

Strychn.  Sulph gr.  1/30 

Ac.  Arsenicosi gr.  1/40 

M.f.  pil.  No.  1.     Tal.  Dos.  LX. . 

S.:     One  pill  after  meals. 

The  potassium  carbonate  here  is  entirely  unnecessary.  It 
only  increases  the  bulk  of  the  pill  and  by  the  deliquescent 
action  is  apt  to  spoil  it.  Physicians  are  used  to  prescribe 
ferrous  sulphate  and  potassium  carbonate  so  as  to  have  freshly 
prepared  ferrous  carbonate.  And  it  is  probably  more  a  matter 
of  habit  than  of  actual  necessity  that  the  potassium  car- 
bonate was  ordered  in  this  prescription. 

385.  Europhen    15.0 

Amyli     45.0 

Apply  externally  to  ulcer. 

Europhen  is  stated  to  be  incompatible  with  starch  because 
a  little  iodine  may  be  liberated  from  the  former  which  would 
combine  with  the  latter  to  form  iodide  of  starch.  As  stated 
in  commenting  upon  another  similar  prescription,  even  if  that 
were  the  case  no  harm  would  result.  The  so-called  iodide  of 
starch  makes  a  very  good  vulnerary  application.  The  pre- 
scription may  be  dispensed  without  any  question. 

386.  locamfen     J  i 

Aquae    3  "i 

S. :     Apply  externally  on  gauze. 

locamfen  is  not  miscible  with  water  and  the  prescription 
should  not  be  dispensed.  The  proper  method  of  using  iocam- 
fen  is  either  pure  or  mixed  with  oil. 

387.  Europhen    3  i 

Ung.  Aquae  Rosae  3  i 

The  borax  contained  in  the  cold  cream  may  liberate  a  small 


PRESCRIPTION  INCOMPATIBILITIES          185 

amount  of  iodine  from  the  europhen.     No  great  harm  will 
result  if  it  does. 

388.  Airol  3  i 

Calomel  3  ss 

Aquae  Calcis 3  iii 

For  external  use. 

Airol  and  calomel  in  the  presence  of  moisture  or  water 
do  not  form  a  desirable  combination,  because  some  of  the 
iodine  from  the  airol  may  combine  with  the  calomel  to  form 
red  mercuric  iodide.  In  this  prescription  there  is  another 
well  known  incompatibility,  namely,  the  black  mercurous 
oxide  is  formed  from  the  action  of  the  lime  water  on  the 
calomel. 

389.  Ess.  Pepsini 3  i 

Ac.  Hydrochlor.  Dil 3  ii 

Magma  Magnesiae  q.s.  ad 5  "i 

S. :     3  ii  after  meals. 

This  prescription  is  absolutely  incompatible.  The  hydro- 
chloric acid  destroys  the  magnesia,  converting  it  into  mag- 
nesium chloride.  This  is  one  incompatibility.  The  other  in- 
compatibility is  between  the  magma  magnesia  and  the  es- 
sence of  pepsin.  Pepsin,  as  we  know,  is  efficient  or  said  to 
be  efficient  only  in  an  acid  medium.  So  if  we  leave  out  the 
hydrochloric  acid  the  activity  of  the  pepsin  will  be  inhibited. 
If  we  leave  in  the  hydrochloric  acid  the  magma  of  magnesia 
is  destroyed.  The  honest  way  to  do  is  to  inform  the  physi- 
cian. Where  it  cannot  be  done  the  prescription  may  be  dis- 
pensed, because  of  course  there  is  nothing  poisonous  in  it. 

390.  Aspirin   1  drachm. 

Sodium  salicylate %  drachm. 

Phenacetine   Vz  drachm. 

Caffeine  citrate 10  grains. 

Ammonium  muriate 

Ammonium  bromide aa        1 1/2  drachms. 

Chloral  hydrate   1  drachm. 

Codeine  sulphate 4  grains. 


186          PRESCRIPTION  INCOMPATIBILITIES 

Tincture  aconite, 
Tincture  gelsemium, 
Tincture  hyoscyamus, 

Tincture  digitalis,  fat-free aa  1  drachm. 

Syrup  glycyr.  compound q.s.  4  ounces. 

Directions:     Two  teaspoonfuls  in  water  every  four  hours. 

This  prescription,  which  is  strictly  bona  fide  and  which 
appeared  in  a  recent  issue  of  the  Bulletin  of  Pharmacy,  is 
presented  here  merely  as  a  curious  example  of  polypharmacy, 
which  was  once  very  prevalent  but  which  is  now  luckily  al- 
most, though  not  entirely,  obsolete.  Now  and  then  we  still  see 
such  a  prescription  in  a  drug  store,  and  as  the  doctor  claims 
that  he  gets  wonderful  results  from  it,  there  is  nothing  left 
to  do  but  to  dispense  it. 

391.     Santonini  gr.  xx 

Calomel gr.  viii 

Sacchari  gr.  xxx 

Div.  in  pulv.  No.  iii. 

One  powder  in  the  morning. 

This  prescription  is  presented  here  merely  for  the  overdose 
of  santonin  which  it  contains.  While  we  may  often  exceed 
the  maximum  dose  given  in  the  Pharmacopeia  and  in  text- 
books on  materia  medica  and  therapeutics,  still  there  is  a 
limit,  and  where  there  is  the  least  doubt  it  is  better  to  be 
on  the  safe  side.  Here  the  druggist  very  wisely  refused  to 
dispense  the  prescription  because  he  considered  seven  grains 
,  of  santonin  to  a  dose  too  risky.  He  telephoned  to  the  physi- 
cian, and  the  latter  apologized,  saying  that  he  meant  to  have 
the  quantities  divided  into  eight  instead  of  three  powders, 
but  evidently  he  left  out  the  Roman  V.  Divided  into  eight 
powders  the  prescription  is  all  right,  because  the  dose  of 
santonin  is  then  2y2  grains,  which  is.not  an  excessive  dos§. 


PRESCRIPTION  INCOMPATIBILITIES          187 

392.  Helmitol  $  i 

Potassii  Bicarbon 5  ss 

Liq.  Potassae   3  i 

Fl.    Ext.   Buchu 3i 

Fl.  Ext.  Uvae  Ursi I  ss 

Aquae   ad    %  vi 

S.:     3  i  four  times  a  day. 

Helmitol  is  chemically  hexamethylenamine-methylene  ci- 
trate, and  it  is  incompatible  with  alkalies  as  it  is  incompatible 
with  acids.  As  this  prescription  contains  two  alkalies,  potas- 
sium bicarbonate  and  potassium  hydroxide,  the  prescription 
is  an  incompatible  one.  The  proper  thing  is  to  notify  the 
physician.  The  incompatibility  is  not  a  dangerous  one,  and 
if  the  physician  cannot  be  reached  the  prescription  may  be 
dispensed  as  written.  True,  the  helmitol  is  decomposed,  but 
the  hexamethylenamine-tetramine  is  left.  The  patient  may 
not  derive  very  much  benefit  from  the  prescription,  but  what 
is  the  druggist  to  do?  As  long  as  nothing  dangerous  hap- 
pens, nothing  particularly  toxic,  and  he  is  unable  to  reach 
the  physician  and  have  him  change  the  prescription,  he  has 
no  other  way  out. 

393.  Saliformin   3  ss 

Aquae 3  "i 

S. :     3  i  four  times  a  day. 

Saliformin  is  chemically  hexamethylenamine  salicylate.  It 
is  not  good  to  prescribe  it  in  water  because  it  hydrolizes  in 
water  into  its  constituents.  The  proper  way  to  prescribe  it 
is  either  in  tablets  or  dissolved  in  some  elixir. 

394.  Pepsini  Optimi 3  i 

Betainae  Hydrochlor 3  iii 

Aquae 3  "i 

S. :     3  i  after  meals. 

This  prescription  is  ' '  perfectly  all  right. ' '  But  the  druggist 
who  received  it  refused  to  dispense  it.  He  thought  that  the 


188         PRESCRIPTION  INCOMPATIBILITIES 

dose  of  betaine  was  excessive,  and  the  reason  he  thought  it 
was  excessive  was  that  he  thought  it  was  an  alkaloid.  And 
the  reason  he  thought  it  was  an  alkaloid  was  that  he  confused 
it  with  and  thought  it  was  the  same  thing  as  betaeucain. 
Betaine  is  a  colorless  crystalline  substance,  containing  about 
24  per  cent,  of  absolute  hydrochloric  acid  and  is  used  in 
various  digestive  disorders  as  a  substitute  for  hydrochloric 
acid.  Its  average  dose  is  eight  grains,  which  corresponds  to 
about  eight  minims  of  diluted  hydrochloric  acid.  And  the 
dose  in  this  prescription  is  just  right.  Betaine  is  also  known 
under  its  trade  name  Acidol. 

395.  Chlorazene 3  ii 

Ac.  Borici   5  ss 

Aquae Oil 

S. :    Use  externally  as  directed. 

Chlorazene,  which  is  a  trade  name  for  dichloramine-T  is 
incompatible  with  acids,  even  with  such  a  weak  acid  as  boric 
acid.  And  we  might  use  this  opportunity  to  state  that  in 
prescribing  new  remedies  physicians  should  be  particularly 
careful  not  to  order  them  in  conjunction  with  other  sub- 
stances. It  is  only  if  they  are  thoroughly  familiar  with  all 
their  possible  incompatibilities,  something  which  is  not  likely 
to  be  the  case  with  the  average  physician,  may  they  indulge 
in  experimenting;  otherwise  they  should  prescribe  them  by 
themselves  or  just  the  way  the  authoritative  textbooks  advise. 

396.  Chloramine-T    3  i 

Hydrogen  Peroxide  %  ii 

Listerine     3  & 

For  external  use  only. 

The  remarks  of  the  previous  prescription  apply  to  this  one 
as  well.  Why  a  physician  who  has  a  powerful  antiseptic 
should  want  to  combine  it  with  several  others  is  hard  to 
understand,  but  such  is  human  nature.  Chloramine-T  is  in- 
compatible with  hydrogen  peroxide,  with  alcohol  and  with  a 
number  of  other  substances. 


PRESCRIPTION  INCOMPATIBILITIES  189 

397.  Halazone  Tablets aa  gr.  v  No.  xxx 

S. :     One  tablet  in  2  quarts  of  water  as  a  douche. 

Undoubtedly  the  physician  in  this  case  was  mixed  up.  He 
heard  or  read  that  halazone  was  a  powerful  antiseptic  or 
disinfectant  and  thought  he  would  use  it  for  medicinal  pur- 
poses. Halazone  is  used  only  for  the  sterilization  of  water 
and  appears  on  the  market  in  tablets  containing  1-15  or  1-30 
of  a  grain.  The  tablets  usually  contain  also  some  sodium 
carbonate  or  borax  and  sodium  chloride.  One  tablet  contain- 
ing 1-15  to  1-30  of  a  grain  of  halazone  is  used  for  the  ster- 
ilization of  one  quart  of  water. 

398.  Hydrargyri  Salicyl  gr.  iv 

Potassii  lodidi   3  iv 

Aquae 3  iii 

S. :     3  i  four  times  a  day. 

The  physician  who  prescribed  this  prescription  most  likely 
thought  that  salicylate  of  mercury  was  soluble  in  water.  Sal- 
icylate  of  mercury  is  practically  insoluble  in  water  and  to 
dispense  it  the  way  it  is  written  would  be  risky,  because  some 
of  it  might  remain  undissolved  and  it  would  be  difficult  to 
have  the  patient  take  an  even  dose.  Mercury  salicylate,  how- 
ever, is  soluble  in  the  halogen  compounds  of  the  alkalies  par- 
ticularly when  the  solution  is  warmed.  The  proper  way 
would  be  to  dissolve  the  potassium  iodide  in  the  water,  heat 
the  solution  and  then  dissolve  the  mercury  salicylate  in  the 
warmed  solution. 

399.  Salophen  3  i 

Natrii  Bicarb 3  ss 

Div.  in  pulv.  No.  vi. 

Salophen  is  incompatible  with  alkalies  in  solution.  But 
as  this  prescription  calls  for  powders  it  is  not  incompatible 
and  may  be  dispensed. 

400.  Hexamethylenaminae    3  iv 

Sodii  Acidi  Phosphatis,  N.  N.  R 5  i 

Aquae 3  iii 

S. :    3  i  three  times  a  day. 


190          PRESCRIPTION  INCOMPATIBILITIES 

As  is  well  known,  hexamethylenamine  acts  best  when  the 
urine  is  acid.  And  the  best  drug  to  make  the  urine  acid  is 
the  acid  sodium  phosphate  as  described  in  the  New  and 
Non-Official  Remedies ;  not  the  official  sodium  phosphate, 
which  is  chemically  Na2HPO4  but  the  acid  phosphate  or  bi- 
phosphate,  which  is  chemically  NaH,PO4.  But  it  is  not  ad- 
visable to  prescribe  the  two  in  the  same  mixture.  The  acid 
sodium  phosphate  should  be  administered  separately.  It  is 
not  a  chemical  or  pharmaceutical  incompatibility  and  the 
druggist  has  no  right  to  refuse  to  dispense  this  prescription ; 
but  it  is  best  the  physician  should  know. 

Those  who  think  that  "shot-gun"  polypharmacy  has  gone 
entirely  out  of  the  fashion,  may  be  somewhat  shocked  by 
contemplating  the  following  prescription,  written  by  a  real 
live  physician  and  reproduced  in  the  Journal  of  the  Ameri- 
can Medical  Association.  Here  it  is : 

401.     #.  Merck's  Colchicin 

"        Strychn.  Phos aa  grs.  ii 

"       Sod.  iodid. 

"       Sod.  salicyl aa  3  x 

Tr.      Belladonna 

"       Bryonia  alb aa    3  ii 

"       Capsicum 3  i 

"       Arnica  mont. 
"       Pulsatilla 

"       Rhus  tox aa  3  v 

"       Phytolocca    3  x 

"       Cimicif.  Rac. 

Colchicum aa  3  xv 

Reed  and  Carnrick's  Elix.  Peptenzyrae .    3  x 
M.  S.:     Take  sixty  (60)  minims  (drops)  in  a  glassful  of 
water,  an  hour  after  each  meal.    Take  every  2  hours 
if  very  severe. 

We  do  not  say  that  it  did  not  do  the  patient  any  good  (or 
harm),  but  it  is  a  curiosity,  anyway. 


PRESCRIPTION  INCOMPATIBILITIES          191 

The  following  prescription  is  taken  from  the  Journal  of 
the  N.  A.  R.  D.  (January  8,  1914)  : 

"From  an  Illinois  pharmacist  comes  the  following  breezy 
note: 

A  country  physician  moved  into  our  city  to  build  up  a  prac- 
tice. He  knew  me  and  we  got  quite  chummy,  and  I  told  him 
that  in  order  to  be  up  to  date  he  must  write  prescriptions  and 
not  do  dispensing. 

He  agreed,  but  said  he  did  not  know  prescription  forms,  as 
he  had  never  written  one ;  so  I  told  him  to  write  the  best  he 
could  and  I  would  make  out  what  he  wanted,  all  right.  The 
first  prescription  was  as  follows,  and  I  have  it  on  file  in  its 
regular  order: 

402.     Quinine  a  little 

Strichnine not  so  much 

Iron a  little  more 

Make  some  capsules;  take  one  every  three  hours. 

And  the  editor  says: 

Comment  is  hardly  necessary,  only  it  shows,  probably  bet- 
ter than  anything  could,  the  looseness  and  criminal  careless- 
ness displayed  in  the  average  dispensing  doctor's  office." 

This  is  either  a  joke  or  a  fib,  or  it  is  true.  If  it  is  a  joke, 
it  is  in  poor  taste.  If  it  is  a  fib,  it  is  an  insult  to  the  medical 
profession.  If  it  is  true,  it  is  a  shame  that  such  physicians 
should  exist. 

But  assuming  that  it  is  true  that  such  physicians  do  exist, 
what  is  the  moral  of  it  ?  The  moral  is  plainly  and  distinctly 
and  indisputably  this:  that  physicians  of  such  type,  who  are 
so  incompetent  to  write  a  prescription,  should  not  write  pre- 
scriptions but  should  dispense  ready  made  preparations  from 
reputable  manufacturing  houses.  I  repeat,  such  physicians 
should  not  exist,  and  it  is  a  shame  that  they  should  be  per- 
mitted to  practice,  but  it  is  a  condition  and  not  a  theory  that 
confronts  us,  and  if  such  physicians  do  exist  and  they  are 
permitted  to  treat  patients,  is  it  not  better  for  the  patients 
that  they  should  dispense  than  to  attempt  to  write  prescrip- 


192         PEESCRIPTION  INCOMPATIBILITIES 

tions  when  they  do  not  know  the  doses  and  are  not  familiar 
with  chemical  and  pharmaceutical  incompatibilities?  There 
is  a  very  good  reason  for  the  vogue  of  good  ethical  pro- 
prietary preparations,  and  all  the  diatribes  against  dispensing 
by  the  physician,  or  against  his  prescribing  of  well  thought- 
out,  skillfully  prepared  proprietary  pharmaceuticals  will  be 
in  vain. 

I  present  the  following  three  prescriptions  as  specimens  of 
herb  recipes.  They  were  written  by  an  old  herb  doctor  with 
an  enormous  practice.  They  were  given  to  me  by  one  of 
my  patients  whom  that  doctor  had  "treated"  for  over  a 
year  for  impotence  with  these  combinations.  Practically 
every  patient  received  the  same  prescriptions. 

403.  Spanish  Sarsaparilla %  oz. 

Yellow  Dock  Root  1/2  oz. 

Skunk  Cabbage  Root %  oz. 

Buchu   ^4  oz. 

Rhubarb  Root  *4  oz. 

Scullcap  , 14  oz. 

Licorice  Root %  oz. 

Senna  i/8  oz. 

Blood  Root    ys  oz. 

Anise  Seeds    y8  oz. 

Steep  these  in  sufficient  hot  water  for  3  hours  to  have  3 
pints  of  tea  when  strained.  Add  when  cold  3  oz.  Rye 
Whiskey.  Dose  2i/2  tablespoonfuls  3  times  a  day,  15  minutes 
before  meals  or  one  hour  after. 

404.  Nerve  Root  1/4  oz. 

Mountain  Ash  Bark ^4  oz. 

Cleavers    14  oz. 

Rhubarb  Root    %,  oz. 

Elecampane  Root %  oz. 

White  Root   %  oz. 

Licorice  Root   %  oz. 

Scullcap  %  oz. 

Anise  Seeds i/8  oz. 

White  Ginger  Root . .  %  oz. 


PRESCRIPTION  INCOMPATIBILITIES          193 

Steep  these  in  sufficient  hot  water  for  3  hours  to  have  3 
pints  of  tea  when  strained.  Add  when  cold  3  oz.  Rye  Whis- 
key. Dose  3  tablespoonfuls  3  times  a  day,  15  minutes  before 
meals  or  one  hour  after. 

405.    Blue  Scullcap %  oz. 

Mountain  Ash  Bark  s %  oz. 

Princes   Pine   y±  oz. 

Sweet  Flag  Root   %,  oz. 

Culver's    Root    %  oz. 

Snakehead  Herb %  oz. 

Marshmallows  ^4  °z- 

Rhubarb  Root %  oz. 

Senna v %  oz. 

White  Ginger  Root    %  oz. 

Steep  these  in  sufficient  hot  water  for  3  hours  to  have  3 
pints  of  tea  when  strained.  Add  when  cold  3  oz.  Rye  Whis- 
key. Dose  3  tablespoonfuls  3  times  a  day,  15  minutes  before 
meals  or  one  hour  after.  Rest  4  days,  then  renew  one  before 
this,  rest  6  days  and  renew  this  one. 

Note  that  Rye  Whiskey  was  an  ingredient  in  each  one  of 
his  prescriptions. 

406  Caffein.  Citratis  3  ii 

Sodii  Salicylatis  3  iv 

Aqua  Destill 3  iy 

S. :  3  i  every  3  hours. 

This  prescription  forms  a  precipitate ;  and  this  precipitate 
has  puzzled  many  pharmacists.  Caffeine  citrate  is  soluble  in 
water,  sodium  salicylate  is  soluble  in  water,  and  if  the  rad- 
icals are  exchanged  the  salts  formed  are  still  soluble,  i.  e., 
caffeine  salicylate  is  soluble  and  sodium  citrate  is  soluble — 
so  why  should  there  be  a  precipitate?  The  explanation  is 
a  very  simple  one.  Caffeine  "citrate"  is  not  a  true  chemical 
compound,  and  for  this  reason  it  is  called  officially  not  caf- 
feine citrate  but  titrated  caffeine.  It  is  really  a  mixture  of 
equal  parts  of  caffeine  and  citric  acid.  Now,  the  citric  acid 


194         PRESCRIPTION  INCOMPATIBILITIES 

being  free,  it  decomposes  the  sodium  salicylate  with  the  forma- 
tion of  sodium  citrate  and  salicylic  acid,  which  latter,  being 
but  slightly  soluble  in  water,  precipitates.  This  incompati- 
bility can  be  easily  avoided  by  using  an  equivalent  quantity, 
which  means  just  one-half,  of  pure  caffeine. 

407.  lodi   gr.  x 

Potassii  lodidi  5  i 

Argyrol    3  i 

Aqua  Destill I  ii 

Use  for  painting  throat. 

This  prescription  is  absolutely  incompatible.  The  argyrol 
is  destroyed,  silver  iodide  being  formed.  Silver  iodide  is 
therapeutically  active,  in  fact  sometimes  too  active,  but  that 
does  not  change  the  fact  that  the  prescription  must  not  be 
dispensed,  because  we  no  longer  have  argyrol  in  it.  The 
physician's  attention  should  be  called  to  the  incompatibility, 
and  if  he  still  wishes  to  have  the  prescription  dispensed  as 
written,  it  is  his  affair. 

408.  Resorcini    gr.  xv 

Petrolati  Liquid!  3  i 

M.f.  sol.    Use  externally. 

Resorcin  not  being  soluble  in  liquid  petrolatum,  it  can  be 
rubbed  up  and  dispensed  as  a  shake  mixture.  But  a  much 
better  way  is  to  dissolve  the  resorcin  in  a  few  drops  of  ether 
and  then  mix  with  the  petrolatum. 

409.  Resorcini    3  ii 

Glycerini    3  ii 

Apply  externally  with  camel's  hair  brush. 
There  is  nothing  whatever  wrong  with  this  prescription. 
One  druggist  refused  to  dispense  it,  saying  that  the  two 
were  incompatible  and  also  that  resorcin  was  not  soluble  in 
glycerin.  There  must  have  been  some  misunderstanding. 
Resorcin  is  perfectly  soluble  in  glycerin  and  perfectly  com- 
patible with  it. 


PRESCRIPTION  INCOMPATIBILITIES          195 

410.  Strontii  Bromidi   3  iii 

Sodii  Bicarbon 3  ii 

Mist.  Rhei  et  Sodae 3  iv 

S.:    Tablespoonful  after  each  meal. 

This  prescription  gives  not  only  a  precipitate  but  a  copious 
effervescence.  The  precipitate  is  due  to  the  formation  of 
strontium  carbonate.  And  where  a  soluble  carbonate  is  used 
in  combination  with  a  soluble  strontium  salt  that  is  all  we 
get.  But  where  a  bicarbonate  is  used,  we  get  also,  besides 
the  precipitate,  an  evolution  of  carbon  dioxide  which  causes 
the  effervescence.  The  following  equation  expresses  the  chem- 
ical reaction: 

SrB*  +  2  NaHCOa  =  SrCO,  +  2  NaBr  +  CO,  +  H20 

If  the  doctor  insists  upon  the  prescription  being  dispensed 
it  may  be  dispensed,  but  it  should  not  be  put  in  the  bottle 
until  all  the  formation  of  gas  has  ceased,  and  the  bottle  in 
which  it  is  put  should  be  of  larger  capacity  than  the  prescrip- 
tion calls  for.  Of  course  it  should  be  dispensed  with  a  shake 
label. 

411.  Protargol    gr.  x 

Cocain.   Hydrochlor gr.  vi 

Aqua  Destill 5  i" 

For  injection. 

Here  we  will  get  gradually  a  white  precipitate  of  silver 
chloride  due  to  the  interaction  between  the  chloride  of  the 
Cocaine  and  the  silver  of  the  protargol.  But  the  trouble  can 
be  easily  prevented  by  using  cocaine  nitrate  instead  of  co- 
caine hydrochloride. 

412.  Acidi  Sulphurosi %  ii 

Aqua  Hydrogenii  Peroxidi §  ii 

Use  as  a  gargle. 

Each  of  the  two  ingredients  is  antiseptic,  but  when  the 
two  are  mixed  both  are  destroyed  and  a  very  weak  solution 
of  sulphuric  acid  is  obtained.  The  reaction  is  expressed  in 
the  following  equation: 


196          PRESCRIPTION  INCOMPATIBILITIES 
H2SO,+  H202  =  H2S04  +  H20 

This  prescription  is  another  example  of  trying  to  get  too 
much  and  of  getting  nothing. 

413.  Quininae  Sulph gr.  iii 

Aspirin!    , gr.  v 

M.  f.  caps.  No.  1.     Tal.  Dos.  vi. 

S. :    One  capsule  every  5  hours. 

For  some  time  the  pharmaceutical  journals  carried  the 
"important"  information  that  quinine  was  incompatible  with 
aspirin,  because  a  very  dangerous  poisonous  compound,  quino- 
toxin,  was  formed,  from  which  many  deaths  resulted.  I  put 
no  credence  in  those  reports  at  that  time,  and  I  do  not  now. 
As  far  as  I  know,  the  two  chemicals  are  perfectly  compatible. 
I  have  prescribed  them  and  have  seen  them  prescribed  with- 
out any  bad  results. 

414.  I.     Tr.  lodi  I  iv 

S. :    Two  teaspoonfuls  to  quart  of  water. 

II.     Tab.  Hydr.  Bichlor aa  0.5,  No.  xii 

So. :    One  in  2  quarts  of  water  as  directed. 

The  young  lady  patient  was  ordered  to  use  the  two  douches 
immediately  following  one  another.  She  did  so  and  expe- 
rienced a  severe  burning  which  lasted  for  over  an  hour.  She 
was  ordered  to  use  these  douches  morning  and  night  and,  in 
spite  of  the  severe  burning  produced  by  the  first  injection,  she 
continued  to  use  them  for  three  or  four  days  until  the  sore- 
ness and  pain  became  unendurable.  When  she  applied  to 
another  doctor  for  treatment  he  found  the  entire  vaginal 
mucous  membrane  in  a  state  of  severe  inflammation  and  so 
sensitive  that  the  introduction  of  a  speculum  caused  excru- 
ciating pain. 

The  physician  who  had  prescribed  those  douches  with  the 
best  of  intentions  was  evidently  not  aware  of  the  fact,  or 
it  had  slipped  his  mind,  that  iodine  and  mercuric  chloride 
produce  mercuric  iodide,  which  is  extremely  irritating.  When 
douches  of  iodine  and  of  bichloride  are  ordered  they  must 


PRESCRIPTION  INCOMPATIBILITIES          197 

not  follow  each  other  too  closely.  Or  a  douche  of  plain 
water  should  be  used  after  the  iodine  douche  or  after  the 
bichloride  douche  so  as  to  remove  the  chemical  from  the 
vaginal  canal  and  to  prevent  the  formation  of  mercuric 
iodide. 

415.  Argenti  Nitr.  0.05 

M.  f.  pil.  No.  1.    Tal.  Dos.  ccl. 

S. :  Pil.  un.  q.  in  die. 

I  reproduce  the  above  prescription,  which  I  dispensed 
dozens  and  dozens  of  times.  The  patient  took  several  thou- 
sands of  these  pills  with  the  result  that  his  face  became  dark, 
then  black  in  streaks,  and  finally  assumed  the  color  of  a 
negro's;  only  it  was  not  uniform,  which  made  the  case  worse. 
Even  while  he  was  getting  black  he  kept  on  taking  the  pills, 
neither  he  nor  the  physician  assuming  a  causal  relationship 
between  the  pills  and  the  "turning  negro."  It  was  one  of 
the  severest  cases  of  argyria  that  I  have  ever  seen.  When 
the  patient  finally  discovered  that  his  black  color  was  not  due 
to  his  disease,  but  to  the  medicine  he  sued  the  physician  for 
damages.  The  patient  was  suffering  with  locomotor  ataxia, 
and  at  that  time  silver  nitrate  was  still  considered  a  remedy 
for  this  disease.  Before  the  case  came  to  trial,  however,  the 
patient  died  and  the  case  was  dropped. 

416.  Pepsin 
Pancreatin 
Taka  Diastase 
Lactopeptine 

Ac.  Hydrochlor.  Dil each  2  dr. 

Mist.  Rhei   et   Sodae 2  oz. 

Ext.  Cascara  Fl 2  oz. 

Elixir  Peptenzyme   1  oz. 

Ess.  Pepsin  Fairchild  3  oz. 

S. :    Tablespoonful  after  each  meal. 

No  prescription  can  demonstrate  better  the  difference  be- 
tween incompatibility  and  non-dispensability  than  the  pre- 


198         PRESCRIPTION  INCOMPATIBILITIES 

scription  before  us.  That  prescription  is  certainly  incom- 
patible, incompatible  chemically,  pharmaceutically  and  thera- 
peutically.  Nevertheless  the  physician  insisted  on  having 
it  dispensed  just  as  written  and  said  that  if  this  drugstore 
did  not  dispense  it  as  he  wanted  it,  he  would  go  somewhere 
else.  He  claimed  that  he  got  first-class  results  with  it  in 
the  worst  cases  of  dyspepsia,  that  his  patients  were  satisfied, 
and  that  it  was  not  the  druggist's  business  to  teach  him  or 
to  make  remarks  about  his  prescriptions.  And  what  are  you 
going  to  do  about  it?  You  simply  have  to  dispense  it.  As 
I  said  many  times  before,  as  long  as  there  are  no  overdoses, 
no  toxic  precipitates,  no  danger  of  explosion,  no  irreparable 
deliquescence,  and  the  mixture  is  presentable  enough  and 
fluid  enough  to  be  poured  from  the  bottle,  and  the  doctor  in- 
sists upon  having  it  dispensed  as  written,  the  pharmacist  has 
no  choice  in  the  matter.  After  all,  he  is  the  servant  and  not 
the  master  of  the  physician. 

417.  Sol.  Fowleri  4.0 

Syr.  Ferri  lodidi    100.0 

S. :  Teaspoonful  in  water  3  times  a  day  after  meals. 
This  prescription  has  been  dispensed  times  without  num- 
ber. The  principal  trouble  is  with  the  carbonate  of  potas- 
sium contained  in  the  solution  of  potassium  arsenite,  which 
precipitates  the  iron  as  ferrous  carbonate.  Most  likely  some 
ferrous  arsenite  is  also  formed  gradually.  The  precipitation 
can  be  avoided  by  using  the  solution  of  arsenous  acid  which 
is  of  the  same  strength  as  the  solution  of  potassium  arsenite. 

418.  Tr.   Nucis   Vomicae    3  iv 

Tr.  Gentianae  Compos 5  i 

Aquae  Menthae  Piper 3  "i 

Sig.:   3  i  t.  i.  d.  p.  c. 

The  turbidity  in  this  prescription  is  due  to  the  fat  con- 
tained in  the  nux  vomica  which  is  kept  in  solution  in  the 
alcoholic  menstruum  of  the  tincture  of  nux  vomica,  separat- 
ing on  the  tincture  being  mixed  with  a  hydro-alcoholic  and 


PRESCRIPTION  INCOMPATIBILITIES          199 

aqueous  menstruum.    Of  course  the  prescription  may  be  dis- 
pensed as  written. 

419.  Bismuth!   Salicyl 15.0 

Ac.    Hydrochlor.    Dil 10.0 

Ess.   Pepsini 25.0 

Aquae   100.0 

S. :    Tablespoonful  after  meal. 

Hydrochloric  acid  is  incompatible  with  bismuth  salicylate 
(the  official  salicylate  of  bismuth  is  not  a  true  salicylate  but 
a  subsalicylate)  ;  a  part  of  the  bismuth  is  decomposed,  bismuth 
chloride  and  then  oxychloride  being  formed  and  salicylic 
acid  separating  out  and  floating  in  the  mixture.  The  pre- 
scription may  be  dispensed,  but  it  is  a  bad  one. 

420.  Bismuth.  Salicyl 3  i 

Natrii  Bicarbon 5  ii 

Mist.  Rhei  et  Sodae 5  ^ 

Aquae  Creosoti   3"  IV 

S. :    J  ss  ter  in  die  post  cibos. 

Sodium  bicarbonate  and  bismuth  salicylate  in  an  aqueous 
mixture  will  gradually  develop  carbon  dioxide,  which  will 
either  cause  the  popping  out  of  the  cork  or  bursting  of  the 
bottle.  Sodium  bicarbonate  or  potassium  bicarbonate  will  do 
this  with  a  number  of  salicylates,  such  as  bismuth  salicylate, 
lithium  salicylate,  or  magnesium  salicylate.  The  products  of 
decomposition  that  are  formed  by  sodium  salicylate  are  bis- 
muth hydrocarbonate,  carbon  dioxide  and  water.  Carbonates 
do  not  cause  an  evolution  of  carbon  dioxide,  only  bicar- 
bonates. 


PRESCRIPTIONS  WITHOUT  CRITICISM 

The  following  prescriptions  are  presented  without  any 
criticism.  Similar  combinations  have  been  analyzed  in  the 
preceding  pages,  and  the  student,  pharmacist  or  physician 
can  test  his  knowledge  of  incompatibilities  by  attempting, 
now  and  then,  to  criticize  some  of  the  prescriptions.  Where 


200          PRESCRIPTION  INCOMPATIBILITIES 

there  is  doubt  or  uncertainty  in  the  reader's  mind,  a  refer- 
ence to  the  Alphabetical  Summary  or  the  Index  should  help 
to  solve  the  difficulty. 

421.  Tr.  lodi 3  ii 

Argenti  Nitr gr.  x 

Aquae    — %  " 

S. :    Gtt.  x  in  water  4  times  a  day. 

422.  Sol.  Adrenalini  Chlor 3  ss 

Petrolati   Liq 3  " 

S. :    Use  as  spray. 

423.  Tr.   lodi    3  iv 

Aq.  Ammon.  Fort 3  iv 

Linim.   Chlorof ormi    3  iy 

S. :    Use  with  friction. 

424.  Ac.  Tannici    3  i 

Aq.   Hydrog.   Perox 3  iv 

Use  as  gargle. 

425.  Argenti  Nitrici   0.3 

Sol.  Arsenic.  Fowleri    5.0 

Aquae    150.0 

S. :    3  i  after  each  meal. 

426.  Dobell's   Solution    V2  pint 

Dioxogen    Vfc  pint 

S. :    For  external  use. 

427.  Zinci  Chloridi   3  ii 

Aquae    5  iv 

S.:    Use  as  injection  twice  a  day. 

428.  Zinci    Oxidi    gr.  ii 

Aquae  Destill 3  iy 

S. :    Use  as  injection  4  times  a  day. 

429.  Resorcin   1.0 

Bism.  Subnitr 4.0 

Zinci   Oxidi    6.0 

M.  f.  ung. 

S. :    Apply  night  and  morning. 


PRESCRIPTION  INCOMPATIBILITIES          201 

430.  Hepar  Sulphuris 3  ii 

Zinci  Sulphatis    3  ss 

Plumbi  Acetatis 3  ss 

Aquae  Rosae   3  vi 

S. :     For  external  use. 

431.  Lysol   I  iii 

S. :    3  i  3  times  a  day. 

432.  Argenti  Nitratis    gr.  v 

Glycotbymoline    3  iy 

S. :    For  external  use  only. 

433.  Sol.  Argenti  Nitr.,  10%   3  iv 

S. :     One  syringeful  3  times  a  day. 

434.  Quin.  Sulph 3  i 

Sodii   Salicyl 3  iii 

Ac.  Sulphur.  Arom 3  i 

Elix.  Glycyrrhiz 3  i 

Aquae 5  ii 

S. :  3  i  every  4  hours. 

435.  Sol.  Ac.  Carbolici,  10%    3  vi 

S. :     Poison!     Apply  externally. 

436.  Potass.  Permangan 3  i 

Ac.  Phenyl 3  ii 

Aquae    3  vi 

S. :    For  external  use  only! 

437.  Peroxide 

Carbolic  Acid, .of  each,  proper  quantity 

To  be  used  as  ordered. 

438.  01.  Palmae  Christi 3  i 

01.  Menthae   gtt.  ii 

S. :     Take  at  one  dose. 

439.  Zinci  Chloridi   3  ii 

Aquae    3  *v 

S. :    Use  externally  as  directed. 


202          PRESCRIPTION  INCOMPATIBILITIES 

440.  Ung.  locli 5  i 

Ung.   Hydrargyri    $  i 

S. :     Apply  3  times  a  day. 

441.  Chloral!  Hydr 3  iii 

Potassii  Brorn 3  iv 

Aquae    3  ii 

S.:     Tablespoonful  at  night. 

442.  Chlorali  Hydrati  3  iv 

Potassii   Brom 3  iii 

Sodii  Brom 3  vi 

Elix.  Simpl 3  ii 

S. :    One  teaspoon  at  night.    May  be  repeated  in  an  hour  if  not 
effective. 

443.  Quin.  Sulphat gr.  iii 

Sodii  Salicyl gr.  v 

M.  f.  pulv.  1.    Make  such  powders  xxiv. 
S.:     One  powder  4  times  a  day. 

444.  Quin.  Sulph 3  i 

Sodii  Salicyl 3  iii 

Elix.  Glycyrrhiz 3  i 

Aquae    \  ii 

S. :    3  i  every  4  hours. 

445.  Sol.  Acidi  Borici,  10% 0  i 

S. :    Apply  on  compresses. 

446.  Ammonii  Carbon gr.  v 

Ammonii  Chloridi  gr.  ii 

Hydrarg.  Chloridi  gr.  1/10 

For  one  caps.    Make  12  capsules. 
S. :     One  3  times  a  day. 

447.  Ac.  Picrici 
Aquae 

S.:     For  external  use.    Bush! 

448.  Tr.   lodi    10.0 

Sol.   Corr.  Sublim.  1-1000   100.0 

S.    For  external  use  only. 


PRESCRIPTION  INCOMPATIBILITIES          203 

449.  Acetphenetidini    3  i 

Antipyrini    3  i 

Spir.  Aetheris  Nitr 5  i 

Liq.  Amm.  Anis 3  ii 

Aquae,  q.  s.  ad 5  *v 

450.  Gran.  Aconitinae aa  gr.  1/20 

No.  xx 
S. :    One  every  J/2  hour. 

451.  Tr.    Ferri    Chloridi    I  i 

Tr.  Cantharidis   3  i 

S. :     Gtt.  xii  ter  in  die. 

452.  Sol.  Potass.  Chlor.,  10%   I  viii 

S. :  Use  as  gargle. 

453.  Ac.  Carbol 3  i 

Collodion    3  iii 

S. :    Paint  with  camel's  hair  brush  around  boil. 

454.  Hydrarg.  Bichlor gr.  iv 

Sol.   Potass.   Permang.,   25% $  iv 

S. :     Apply  externally  as  directed. 

455.  Atropinae  Sulph gr.  iii 

01.   Olivae    3  iv 

S. :     Caution !     Apply  small  quantity  every  hour  until  pain  is 
relieved. 

456.  Atropinae  Sulph gr.  iv 

Aquae  Destill '. §  iv 

S. :    3  i  3  times  a  day. 

457.  Hydrarg.   Chlor.   Corros gr.  iv 

Syr.  Hypophosph.  Comp 3  ^ 

Aquae    5  i 

Elixir.  Simpl 3  i 

S.:     3  i  t.  i.  d.  p.  c. 

458.  Potassii   lodidi    3  ii 

"       Brom 3  iii 

Sodii  lodidi    3  ii 

"      Brom.  .  3  iii 


204          PRESCRIPTION  INCOMPATIBILITIES 

Tr.  Ferri  Sesquichlor 3  i 

Aquae,  q.  s.  ad 3  viii 

S. :    314  times  a  day. 

459.    Aquae  Destillatae,  U.  S.  P 1000.0 

Recente  paratae,  sterilizatae ! 
Pro  usu  doctoris. 


Quin.  Sulphat 3  ii 

Ac.  Sulph.  Dil.,  q.  s. 

Tr.  Ferri  Chloridi 3  iv 

Syrupi    3  i 

Aquae    , 3  iii 

S. :    3  i  ter  in  die. 

461.  Antipyrini  5  ii 

Aquae  Destill 3  i 

S. :    For  external  use! 

462.  Hydrargyri  Bichlor gr.  iv 

Potassii  lodidi 3  ii 

Argenti  Nitratis gr.  viii 

Aquae    3  iv 

S. :     3  i  3  times  a  day. 

463.  Phenol  (100%)   3  i 

S. :    For  external  use. 

464.  Ichthyol    3  i 

Creosoti  3  ss 

Guaiacol    3  i 

Div.  in  caps.    No.  xxx. 

S. :     Two  capsules  3  times  a  day. 

465.  Hydrarg.  Chlor.  Mitis 3  ii 

Ung.  lodi   3  vi 

M.  f.  ung. 

S.:     Apply  with  friction  3  times  a  day. 

466.  Sol.   Magendie    3  i 

Tr.  Lavand.  Comp 3  iii 

Aquam,  q.  s.  ad 3  ii 

S.:    3  i  pro  re  nata. 


PRESCRIPTION  INCOMPATIBILITIES          205 

467.  Sol.  Magendie   gr.  iv. 

S. :     Gtt.  viii  as  required. 

468.  Potassii  lodidi  3  ss 

Syr.  Ferri  lodidi 3  Ui 

S.:    3  i  in  water  3  times  a  day. 

469.  Potass.  Permang. 3  i 

Glycerini    3  i 

Aquae    3  "i 

S. :    For  external  application. 

470.  Sodii  Salicyl 3  ii 

Spir.  Aetheris  Nitr 3  i 

Ammon.  Carbon 3  i 

Aquae    3  *& 

471.  Ac.   Arsenosi    0.06 

Strychn.  Sulph 0.06 

Quin.   Sulph 0.6 

Massae  Ferri '  Carbon 6.0 

Div.  in  pil.  No.  xxx. 
S. :     One  3  times  a  day. 

472.  Chlorali  Hydrati  gr.  v 

01.  Theobroin gr.  xx 

M.  f.  suppos.  No.  i.    Tal.  Dos.  viii. 

S. :     Insert  two  suppositories  at  night,  one  after  the  other. 

473.  Pil.  Hydrarg.  Chlor gr.  V8 

No.  xxx 

S. :    One  t.  i.  d.  after  meals. 

474.  Sulphuris    3  ii 

Bals.  Peruv I  ss 

Petrolati    3  i 

S. :    Rub  on  at  night. 

475.  Sulphuris    3  ii 

Bals.  Peruv 3  ss 

Adipis   ^  i 

M.  f.  ung. 

S. :     Apply  at  night. 


206          PRESCRIPTION  INCOMPATIBILITIES 

476.  Emulsionis  Olei  Morrhuae,  50% 

Spir.  Frumenti   aa  3  viii 

S.    5  ss  after  meals. 

477.  Oleores.  Cubebae 3  iv 

Fl.  Ext.  Buchu 3  vi 

01.   Santali 3  ii 

Aquae    3  *v 

S. :    313  times  a  day. 

478.  Hydrargyri  Sublim gr.  ii 

Potassii  lodidi 3  ii 

Ac.  Nitrohydrochlor 3  ii 

Ess.  Pepsini  §  i 

Aquae    J  ii 

S. :    3  i  ter  in  die  after  meals. 

479.  Trional   gr.  v 

Veronal    gr.  x 

Medinal    gr.  v 

Ft.  pulv.  1.    Tal.  Dos.  vi. 
S. :     One  on  retiring. 

480.  Morph.  Sulph gr.  ii 

Heroini    .' gr.  ii 

Dionini    gr.  ii 

Codeinae    gr.  vi 

Ammon.  Mur 3  iss 

Syr.  Tolut 3  i 

Aquae,  q.  s.  ad 3  ii 

S.:    3  i  3  times  a  day. 

481.  Tr.  Ferri  Chlor 3  iv 

Potass.  Chloratis  3  iv 

Glyeer.  Ac.  Tannici   3  i 

S.:    3  i  in  water  for  gargling. 

482.  Pilocarpinae  Nitr 3  ij 

Bay  Rum  3  viij 

S. :    To  be  used  on  scalp  night  and  morning. 


PRESCRIPTION  INCOMPATIBILITIES          207 

483.  Potassii  Brom %  i 

Sodii  Brom 3  i 

Ammonii  Brom 3  ss 

Calcii   Brom 5  ss 

Strontii  Brom 3  ss 

Potassii  Acetatis    5  i 

Sodii  Citratis    3  i 

Lithii  Citratis  3  i 

Aquae,  q.  s §  xxij 

S. :    3  ss  i°  glass  of  water  on  rising  and  on  going  to  bed. 

484.  Ichthyol,  pure   §iv  (!) 

S.:     Teaspoonful  3  times  a  day  after  each  meal. 

485.  Tabloids  Three  Bromides  B.  W.  and  Co.  No.  C. 
S. :     Three  tablets  in  glass  of  water  4  times  a  day. 

486.  lodi    3  i 

Adipis  Lanae  3  i 

M.  f.  ung. 

S.     Apply  externally  night  and  morning. 

487.  Zinci  Sulphatis  gr.  v 

Mellis  Boracis   3  " 

S.:     Use  externally  with  swab. 

488.  Creosotal    3  i 

Guaiacol  3  i 

01.  Amygd.  Express 3  ii 

01.  Amygd.  Amar gtt.  v 

Div.  in  caps.  No.  xxx. 

S.:     Two  capsules  3  times  a  day. 

489.  Arseni  Trioxidi   gr.  1/30 

Hydrarg.  Bichlor gr.  1/16 

Quin.  Sulph gr.  i 

Massae  Ferri  Carbon gr.  iii 

M.  f.  pil.  No.  1.    Tales  Doses  xl. 

S. :     One  pill  3  times  a  day  after  meals. 


208          PRESCRIPTION  INCOMPATIBILITIES 

490.  Sol.  Potass.  Arsen 5  iij 

Hydrarg.   Bichlor gr.  v 

Quin.  Sulph gr.  xl 

Tr.  Ferri  Chloridi 3  vi 

Aquae,  q.  s.  ad 3  v 

S.:    3  i  ter  in  die  p.  c. 

491.  Tr.    Cinchonae    %  i 

Tr.  Ferri  Chloridi  3  i 

Tr.  Cantharidis  5  ii 

S. :  Gtt.  xv  t.  i.  d.  in  Vichy  Water. 

492.  Airol    3  iv 

Aquae 3  iv 

S. :    Use  as  injection. 

493.  Ammon.   Benz 3  i 

Sodii  Benz 3  iii 

Ac.  Hydrochlor.  Dil 5  ii 

Ess.   Pepsini    3  ss 

Aquae  3  "J 

S. :    3  ii  after  meals. 

494.  Quin.  Sulph 3  ii 

Tr.  Digitalis 3  iv 

Liq.  Ferri  et  Ammon.  Acet 3  V1 

S.:    3  i  quaqua  hora  tertia. 

495.  Ext.  Pituitary   gr.  »/t 

Ext.  Thyroid    gf.  % 

Ext.  Adrenal   gr.  i 

Ext.  Orchitic   gr.  ii 

M.  f .  caps.  No.  1.    Tal.  Dos.  Ix. 

496.  Ext.   Parathyroideae    q.s. 

To  make  60  capsules  each  to  contain  the  usual  dose. 

497.  Apothesine,  10%,   * 3  iv 

S.:    For  external  use. 


PRESCRIPTION  INCOMPATIBILITIES          209 

498.  Salol  3  ii 

Spin  Aetheris  Nitrosi 3  i 

Fl.  Ext.  Buchu ;. .  3  iv 

Aquae     5  i83 

S. :    3  i  every  4  hours. 

499.  Spirosal    3  il 

Ol.  Olivae §  i 

S. :    For  external  use. 

500.  Sodii  Thiosulph 5  ss 

Ac.  Hydrochlor 3  ii 

Ess.  Pepsini 3  i 

Syr.   Zingiberis    %  i 

Aquae    §  vi 

S. :    J  ss  after  meals. 

501.  Zinci  Oxidi  1.0 

Camphorae    0.2 

Ung.  Simpl 25.0 

M.  f .  ung. 

S. :    Apply  to  the  eyes  once  a  day. 

502.  Phosphori   gr.  1/100 

Ext.  Nuc.  Vom gr.  ^4 

Ferri  Reducti    gr.  ii 

M.  f.  pil.  1.    Fiant  pil.  Ix. 
S. :     One,  night  and  morning. 

503.  Liq.  Plumbi  Subacet 3  ss 

Ichthyolis 3  ii 

Olei   Olivae    §  ii 

S.:    For  external  use. 

504.  Phenyl  Salicyl 3  iii 

01.  Amygdal ,  3  vi 

01.  Amygdal.  Am gtt.  vi 

Aquae    $  iii 

S.:     3  i  3  times  a  day. 


210          PBESCRIPTION  INCOMPATIBILITIES 

505.  Sulphuris    Loti    gr.  v 

Potassii  Bitartr gr.  x 

M.  f .  Tab.  No.  1.    Mitte  C. 

S. :     One  tablet  4  or  5  times  a  day. 

506.  Lupulini    gr.  iii 

Camphorae    gr.  iv 

M.  f .  pil.  1.    Tal.  Dos.  xxiv. 

S.:    One  pill  at  6  p.  m.  and  one  on  retiring. 

507.  lodof ormi   gr.  xii 

Bism.  subnitr gr.  xxiv 

Div.  in  bacil.  urethr.  No.  xii. 
S.:    Insert  one  4  times  a  day. 

508.  Tr.  lodi 3  iv 

Ac.  Carbolici   3  iv 

S. :    Gtt.  iv  in  water  every  2  hours. 

509.  Potassii  Brom 3  ii 

Chloral   3  i 

Div.  in  suppos.  rect.  No.  xii. 
Insert  one  at  night 

510.  01.  Ricini   5  ij 

M.  f.  Emuls. 

S. :  3  ss  every  hour. 

511.  Strychn.    Sulph gr.  ii 

Quininae  Bisulph 3  ij 

Ac.  Sulph.  Arom 3  i 

Liq.  Ferri  et  Ammon.  Acet %  iv 

S. :    Two  teaspoonsful  4  times  a  day. 

512.  Bromoformi    15.0 

Aquae    150.0 

M.  f.  Emuls.  lege  artis. 

S.:    Teaspoonful  every  hour  until  relieved,  then  every  3 
hours. 

513.  Chloral 

Camphor  5£  50.0 

S.:     Apply  externally. 


PRESCRIPTION  INCOMPATIBILITIES          211 

514.  Chlorali  Hydrati   4.0 

Camphorae    2.0 

Syr.  Tolutani  15.0 

Aquae   45.0 

S.:     Cochlear  parvum  ter  in  die. 

515.  Bism.  et  Ammonii  Citratis  15.0 

Acidi  Nitrici  Diluti    q.  s. 

Ess.  Pepsini  25.0 

Aquae    100.0 

S.:    Tablespoonful  after  meals. 

516.  Tr.  Ferri  Mur 20.0 

Spir.  Amm.  Arom 15.0 

Syrupi   25.0 

Glycerini   25.0 

Aquae    125.0 

S.:     Teaspoonful  after  meals. 

517.  Argenti  Nitr gr.  xij 

Glycerini    3  i 

Aquae  3i 

S. :    Drop  3  drops  into  each  eye  morning  and  night. 

518.  Sol.  Magendie   3  i 

Ammon.  Carbon 3  ii 

Syr.  Ipecac 3  iv 

Syr.  Pruni  Virg 3  vi 

Aquae,  q.  s.  ad 3  "* 

519.  Ac.  Chromic 3  i 

Glycerini   3  iv 

Aquae  3  iv 

S. :     Caustic.     Use  with  caution. 

520.  Copaibae 

Cubebae  Oleores aa  3  i 

01.   Santali    •.•_••.••*. 3  ii 

Div.  in  caps.  No.  xii. 

S. :     One  3  times  a  day. 


212         PRESCRIPTION  INCOMPATIBILITIES 

The  following  prescriptions,  including  the  comments,  were  sent 
to  me  at  my  request  by  Mr.  J.  L.  Lascoff,  a  well-known  pharmacist 
of  this  city,  whom  I  take  this  opportunity  to  thank  for  his  courtesy. 
They  are  all  prescriptions  that  were  dispensed  at  his  pharmacy. 

521.  Tr.  Ferri  Chloridi 10.0 

Antipyrini    0.12 

Spiritus  Aetheris  Nitrosi   15.0 

Aquae  ad  100.0 

M.  D.  S.    A  teaspoonful  every  hour. 

The  antipyrin  is  added  to  produce  a  color  reaction  with 
the  iron  and  as  such  is  harmless ;  but  with  the  addition  of  the 
sweet  spirit  of  niter,  a  sharp  chemical  reaction  takes  place. 
At  first  there  is  a  purple  mixture  formed  with  the  iron  and 
the  antipyrin,  then  when  the  niter  is  added  it  turns  light 
green,  and  then  when  allowed  to  stand  becomes  olive  green, 
and  later  brown.  Chemically  an  iso-nitroso-antipyrin  is 
formed  which  is  considered  by  many  a  poisonous  compound. 
This  prescription  as  written  is  incompatible.  The  only  rem- 
edy is  to  use  the  simple  spirit  of  ether,  which  was  done  in 
this  case  by  consent  of  the  prescriber.  [As  the  antipyrin  is 
added  merely  as  a  coloring  agent,  while  the  spirit  of  nitrous 
ether  possesses  decided  therapeutic  properties,  it  is  better  to 
leave  out  the  former,  i.  e.,  the  antipyrin,  and  leave  in  the 
latter — the  spirit  of  nitrous  ether. — W.  J.  R.] 

522.  Potassii  Citratis 10.0 

Liquoris  Ammonii  Acetatis 

Spiritus  Aetheris  Nitrosi,  aa 30.0 

Tincturae  Cardamomi  Compositae 15.0 

Aquae,  q.  s.  ad 240.0 

A  teaspoonful  every  three  to  four  hours  in  water. 

When  the  above  is  compounded  four  changes  of  color  take 
place  as  the  result  of  chemical  change.  At  first  it  is  light 
brown,  then  red,  then  straw  color,  and  finally  becomes  pur- 
ple. This  is  all  due  to  the  presence  of  the  niter,  which  con- 
tains nitrous  acid. 


PRESCRIPTION  INCOMPATIBILITIES          213 

523.  Potassii  iodidi    8,0 

Spir.  Aetheris  Nitrosi 30.0 

Liq.  Ammon.  Acetatis   60.0 

Potassii   Citratis    4.0 

Aquae,  q.  s.  ad 180.0 

M.  S.  A  teaspoonful  every  four  hours  in  water. 
This  prescription  is  somewhat  similar  to  the  preceding  one, 
but  contains  an  additional  ingredient,  KI.  If  dispensed  in 
the  order  as  written,  it  is  entirely  incompatible,  but  a  clear 
mixture  will  result  if  put  up  as  follows :  Dissolve  the  potas- 
sium citrate  in  sufficient  water,  and  add  the  solution  of  am- 
monium acetate,  followed  by  the  nitrous  ether;  then  dissolve 
the  KI  in  the  remainder  of  the  water  and  mix  both  solutions. 

524.  Tincturae  Benzoini  Compositae  30.0 

Codeinae  Sulphatis  0.5 

Syrupi  Tolutani,  ad 180.0 

M.  D.  S.:     Two  teaspoonfuls  every  four  hours. 
By  mixing  the  ingredients  as  written,  the  benzoin  settles 
down  along  the  sides  and  neck  of  the  bottle.    We  added  8.0 
gum  acacia,  emulsifying  the  benzoin ;  no  precipitation  occurs 
then. 

525.  Tinct.  lodi gtt.  xx 

Mentholis    gr.  viii 

Alboleni    1  oz. 

M.  D.  S. :    Use  as  a  spray. 

If  compounded  as  written,  a  turbid  mixture  results,  on 
account  of  the  alcohol  and  water  in  the  tincture  of  iodine, 
and  the  oil.  But  by  using  iodine  crystals  with  a  few  grains 
of  KI  equivalent  to  tincture,  we  eliminate  the  alcohol  and 
water,  and  a  clear  uniform  mixture  results. 

526.  Tr.  lodi 

Aq.  Ammon.  Fort aa  15.0 

Lin.  Saponis  Camphor,  q.  s.  ad 60.0 

Liniment;  use  externally. 
On  mixing  the  above  mentioned  ingredients  a  liniment  re- 


214         PRESCRIPTION  INCOMPATIBILITIES 

suits  which  is  first  of  a  dark  shade ;  it  gradually  gets  lighter, 
then  yellow,  and  finally  becomes  colorless.  [This  is  of  course 
due  to  the  iodine  combining  with  the  ammonia,  forming  the 
colorless  ammonium  iodide. — W.  J.  R.] 

527.  Orthoformi    8.0 

Olei  Olivae  120.0 

M.  ft.  sol. 

In  order  to  make  a  uniform  and  clear  mixture,  it  is  neces- 
sary to  heat  the  two  ingredients,  as  the  orthoform  is  insoluble 
in  the  cold  oil. 

528.  Sodii  lodidi  20.0 

Elixiris  Ferri,  Quin.,  et  Strychn.  Phosph 180.0 

M.  D.  S. :    A  teaspoonful  three  times  a  day  after  meals. 
In  this  prescription  the  phosphate  salts  are  incompatible 
with  the  sodium  iodide,  therefore  we  use  the  N.P.I.Q.S.  which 
makes  a  clear  and  uniform  solution.    "We  find  the  same  incom- 
patibility when  using  bromide  salts. 

529.  Tinct.  Nucis  Vomicae   8.0 

Tinct.  Cardamomi  Comp. 

Elix.  Ferri  Quininae  et  Strychninae  Phosphatum  60.0 

Elixiri  Digestivi   (N.  F.) 60.0 

S. :     A  teaspoonful  after  each  meal. 

In  this  case,  one  should  also  use  the  N.F.  preparation  of 
the  I.Q.S.,  which  contains  the  tincture  of  ferric  citro-chloride, 
otherwise  the  mixture  is  turbid  and  not  uniform.  (N.  B.— 
Elixir  I.Q.S.  phosphates  is  not  official  now.) 

530.  Brometone    0.12 

Pyramidon   0.3 

D.  T.  D.  Capsulae  No.  12. 

Sig.:     One  every  3  hours  until  relieved. 
When  these  two  ingredients  are  mixed  a  soft  mass  results. 
To  avoid  this  I  added  a  small  amount  of  Magnesium  Oxide 
and  triturated  it  very  gently,  filled  in  capsules  and  dispensed 
in  a  glass-stoppered  bottle 


PRESCRIPTION  INCOMPATIBILITIES          215 

531.  Sparteinae  Sulphatis   0.05 

Sacchari  Lactis  q.  s. 

M.  f.  tabellae  (freshly  prepared)  No.  12. 
Sig. :     One  every  4  hours. 

In  making  ordinary  tablets  we  always  use  diluted  alcohol ; 
in  this  case  we  used  ether  and  absolute  alcohol,  otherwise 
the  tablets  would  be  too  soft  and  stick  together;  it  would 
also  be  impossible  to  remove  them  from  the  mold. 

532.  Heroini  Hydrochl gr.  1/20 

Quininae  Hydrochl gr.  1/2 

Creosoti  Carbonatis  (Duotal)   min.  10 

Tal.  dos.  soft  capsules  No.  xxx. 

Sig.:     One  every  4  hours. 

"We  made  a  pill  mass  of  the  first  two  ingredients.  We 
placed  the  pill  in  each  capsule,  then  dropped  10  min.  of  the 
duotal  in  each  soft  capsule,  sealed  them  properly  and  washed 
them  off  with  pure  alcohol. 

533.  Quininae  Hydrobrom 6.0 

Camphorae  Monobromatae   4.0 

Ergotini    4.0 

Creosoti  Carbonatis 6.0 

Divide  into  capsules  No.  xxx. 

Sig. :    One  three  times  a  day. 

To  the  creosote  carbonate  I  added  acacia  and  a  few  drops 
of  water,  emulsified  it,  added  the  first  three  ingredients  v/hich 
were  previously  mixed  in  a  separate  mortar,  and  made  a 
mass  with  the  addition  of  30  grains  of  magnesium  oxide  and 
sugar  of  milk.  It  was  impossible  to  dispense  this  in  soft 
capsules,  and  it  was  also  difficult  to  make  a  mass.  Without 
the  addition  of  MgO  the  Creosote  Carbonate  would  separate. 

531.    Mentholis   5.00 

Phenolis    ,  3.00 

Zinci  Oxidi  20.0 

MgC03    6.00 

Glycerini   5.00 


216          PRESCRIPTION  INCOMPATIBILITIES  . 

Olei  Amygdal.  Dulcis 30.00 

Aquae  Calcis    80.00 

Aquae  Rosae,  q.  s.  ad 240.00 

Sig.:    Dab  on  skin  every  2  hours. 

This  lotion  is  frequently  prescribed  by  a  prominent  skin 
specialist  who  complained  that  a  solid  mass  forms  on  the 
bottom  of  the  bottle,  the  lime  and  rose  water  being  separated, 
and  not  fit  for  use.  He  asked  me  to  experiment  with  it,  and 
I  solved  the  problem  by  dispensing  it  as  follows:  I  mixed 
the  zinc  oxide  with  double  the  amount  (12.00)  MgC03  in  a 
mortar,  to  this  I  added  the  almond  oil  and  lime  water  pre- 
viously mixed,  triturated  this  well,  added  the  glycerin  and  rose 
water  and  put  this  mixture  in  the  8-oz.  bottle.  Then  mixed 
the  menthol  with  the  phenol  in  a  mortar  and  added  it  to  the 
mixture.  It  formed  an  elegant  lotion,  which  was  perfectly 
white  and  uniform.  The  reason  for  the  addition  of  MgC03 
is  to  make  it  more  alkaline.  The  physician  accepted  my  sug- 
gestion. 

535.  Camphor    2.0  grammes 

Mix  and  make  30  pills. 

We  triturate  the  camphor  with  about  1  gram  of  powdered 
soap  and  add  a  few  drops  of  castor  oil.  This  makes  a  mass 
which  does  not  harden.  It  should  be  dispensed  in  a  glass 
container  well  corked.  [In  the  author's  opinion  it  would 
be  simpler  and  altogether  preferable  to  powder  the  camphor 
and  fill  it  dry  in  30  capsules.  It  is  good  to  inform  the  doctor 
that  it  is  much  better  to  dispense  camphor  in  capsule  than 
in  pill  form.— W.  J.  R.] 

536.  Camphor   20  grains 

Menthol   10  grains 

Mix  and  make  25  pills. 

Triturate  the  camphor  and  menthol.  To  the  resulting  liq- 
uid add  a  mixture  of  extract  of  glycyrrhiza  and  powdered 
glycyrrhiza,  and  then  a  few  drops  of  water,  This  makes  a. 


PRESCRIPTION  INCOMPATIBILITIES          217 

very  good  mass.     The  finished  pills  should  be  coated  to  pre- 
vent evaporation  of  the  camphor. 

537.  Ammonium  Chloride  4.0  grammes 

Powdered  Camphor 0.6  grammes 

Syrup  of  Wild  Cherry 30.0  grammes 

Distilled  water,  enough  to  make 120.0  grammes 

Triturate  the  camphor  with  1  gram  of  granulated  acacia 
to  a  fine  powder  and  then  add  the  syrup  and  water  little  by 
little. 

The  following  prescription  was  sent  to  me  for  experiment 
by  the  Druggists  Circular.  (See  Jan.,  1919,  page  21.) 

538.  Acetanilid  3  oz. 

Phenacetin 2  oz. 

Salol  1  oz. 

Caffeine    1  oz. 

Ac.  Tart gr.  ccxxx 

Sod.  Carbonat 3  oz. 

Spt.  Vin.  Rect.  Dil cong.  1 

I  experimented  with  4  oz.  I  dissolved  the  acetanilid  in  3 
drams  of  alcohol,  the  phenacetin  in  1  oz.  of  alcohol,  and  the 
salol  and  caffeine  in  5  drams  of  alcohol  (2  oz.  of  alcohol  in 
all),  and  then  mixed  the  three  solutions.  The  tartaric  acid 
and  sodium  carbonate  were  dissolved  together  in  2  ounces  of 
water.  Then  the  aqueous  solution  was  gradually  added  to 
the  spirituous  one,  when  no  untoward  result  ensued. 

539.  Resorcini    2.3 

Sodii  Boratis 5.0 

Cocaini  Hydrochloridi  1.0 

Aquae  Foeniculi  200.0 

Tincturae  Opii  Crocatae gtt.  xx 

Sig. :     Eye  lotion. 

This  makes  a  turbid  mixture.  If  filtered,  al)  the  active  in- 
gredients will  be  removed.  By  substituting  boric  acid  for 
borax  a  clear  solution  is  obtained.  In  a  similar  case  a  leading 
oculist,  who  prescribed  holocaine  with  borax,  was  glad 


218          PRESCRIPTION  INCOMPATIBILITIES 

to  accept  my  suggestion  that  boric  acid  be  substituted  for  the 
borax.  [Borax  being  alkaline  is  incompatible  with  alkaloids. 
See  prescription  28.— W.  J.  R.] 

540.  Creosoti    c.  c.  0.12 

Balsam  of  Tola  gm.  0.2 

M.  ft.  pill,  Mitte  No.  50. 

It  is  easy  enough  to  put  this  prescription  in  capsules,  but 
to  make  pills  of  it,  the  following  method  should  be  adopted : 
Emulsify  the  creosote  with  a  little  acacia,  adding  finely  pow- 
dered balsam  of  tolu,  with  enough  powdered  glycyrrhiza  to 
make  a  suitable  mass.  [A  very  ingenious  method,  indeed. 
And  if  the  doctor  insists  on  prescribing  creosote  in  pill 
form,  the  pharmacist  has  no  choice ;  but  I  feel  in  duty  bound 
to  utter  my  protest  once  more  against  the  irrational  practice 
of  prescribing  and  dispensing  liquids  in  pill  form. — W.  J.  R.] 

541.  Ox  Gall  gm.    16.0 

Oil  of  Turpentine    c.  c.     30.0 

Glycerin    c.  c.  120.0 

Ft.  sol.     Sig. :     Dissolve   one-fourth   part   in   a  quart  of 
water  and  use  as  an  enema. 

Compounded  in  the  order  in  which  the  ingredients  are 
named  it  will  be  impossible  to  produce  a  clear  and  uniform 
mixture;  but  by  triturating  the  ox  gall  with  a  little  of  the 
glycerin  and  emulsifying  the  oil  of  turpentine  with  this,  add- 
ing lastly  the  remainder  of  the  glycerin,  a  satisfactory  mix- 
ture will  be  effected. 

542.  Resorcini   0.8 

Mentholis    0.8 

Benzoinolis   Liq 90.0 

Sig. :    Use  as  a  spray. 

As  resorcin  is  not  soluble  in  the  oil,  we  dissolved  it  in  10 
or  15  drops  of  ether,  the  menthol  being  dissolved  in  the  oil 
previously  warmed.  A  nice  dear  solution  was  obtained, 


ALPHABETICAL  SUMMARY 

OF 
PRESCRIPTION  INCOMPATIBILITIES 

Acacia.  A  solution  of  this  gum  forms  a  thick  unsightly 
precipitate  with  a  solution  of  lead  subacetate  (but  not  with 
lead  acetate),  a  concentrated  solution  of  borax,  ferric  salts 
and  alcohol  or  alcoholic  tinctures.  The  precipitation  with 
borax  does  not  occur  if  the  mixture  contains  a  fairly  large 
amount  of  syrup  or  glycerin;  there  is  no  precipitate  with 
ferric  salts  if  the  mixture  contains  a  considerable  amount 
of  free  acid  or  if  the  ferric  salt  is  well  diluted  with  water, 
syrup  or  glycerin.  With  alcohol  the  precipitate  takes  place 
only  when  the  percentage  of  the  alcohol  is  60  or  over.  It 
is  colored  blue  by  tincture  of  guaiac.  Acacia  often  acts  as 
a  preventative  of  precipitation.  Notably  it  prevents  the 
precipitation  of  alkaloids  by  tannic  acid  or  even  potassium- 
mercuric  iodide  (Mayer's  reagent). 

Acetanilid.  With  spirit  of  nitrous  ether  it  gives  a  yellow 
solution  turning  to  red.  It  liquefies  on  being  triturated  with 
phenol,  resorcin  and  thymol;  with  chloral  hydrate  it  gives 
a  damp  powder. 

Acetates.  Soluble  acetates  give  a  deep  red  color  with  ferric 
salts,  due  to  the  formation  of  ferric  acetate  (as  in  Basham's 
mixture).  With  quinine  salts  they  give  a  bulky  pasty  pre- 
cipitate of  quinine  acetate.  [Try,  for  instance,  quinine  bi- 
sulphate  with  sodium  acetate.]  Morphine  acetate  loses  some 
acetic  acid  on  exposure  and  becomes  less  soluble.  Lead 
acetate  on  exposure  loses  some  acetic  acid,  attracts  carbon 
dioxide  and  becomes  partially  converted  into  lead  carbonate. 
219 


220          PRESCRIPTION  INCOMPATIBILITIES 

Acetozone.  Decomposed  on  being  heated  with  water,  or  in 
contact  with  alkalies. 

Acida.  Acids.  Practically  all  acids  decompose  carbonates 
and  bicarbonates  with  effervescence  and  the  liberation  of  car- 
bon dioxide,  and  the  formation  of  salts  of  the  corresponding 
acid.  Hydrocyanic  Acid  is  an  exception.  Remember  that 
Carbolic  Acid  is  chemically  not  an  acid  and  does  not  act  like 
one. 

Acidum  Glycerophosphoricum  is  not  used  per  se  and  will 
therefore  be  referred  to  under  the  head  of  its  salts,  the 
glycerophosphates. 

Acidum  Aceticum.  1.  In  common  with  other  acids,  it  de- 
composes carbonates,  forming  an  acetate  and  liberating  C02. 
2.  With  a  mixture  of  alcohol  and  sulphuric  acid,  as  in  aro- 
matic sulphuric  acid,  it  forms  acetic  ether  or  ethyl  acetate. 

Acidum  Arsenosum.    See  Arseni  Trioxidum. 

Acidum  Benzoicum.  This  acid  is  but  slightly  soluble  in 
water,  but  very  soluble  in  alcohol :  it  is  thrown  out  from  its 
alcoholic  solution  by  the  addition  of  water.  Its  solubility  in 
water  is  increased  considerably  by  the  presence  of  borax. 
See  Benzoates. 

Acidum  Carbolicum.     See  Phenol. 

Acidum  Chromicum.     See  Chromii  Trioxidum. 

Acidum  Gallicum.  Gives  bluish-black  color  with  ferric  salts, 
and  also  with  ferrous  (because  practically  we  seldom  meet 
with  chemically  pure  ferrous  salts  entirely  free  from  ferric 
compounds).  With  ammonia  compounds  (aromatic  spirit 
of  ammonia)  it  gives  a  variably  colored  mixture  and  precipi- 
tate. With  lime  water  a  bluish- white  (or  rather  dirty)  pre- 
cipitate. With  excess  of  sodium  bicarbonate  is  said  to  give 
indigo  blue  color  with  blue-green  precipitate.  Vigorous  tritu- 
ration  with  potassium  permanganate  may  cause  an  explosion 
with  the  burning  up  of  the  acid. 

Acidum  Picricum.  Trinitrophenol.  1.  Liable  to  explode 
unless  carefully  handled.  2.  Must  not  be  rubbed  or  heated 


ALPHABETICAL   SUMMARY  221 

with  readily  oxidizable  substances,  as  an  explosion  may  occur. 
3.  Forms  a  precipitate  with  most  alkaloids. 

Acidum  Tannicum.  1.  Its  most  important  incompatibility 
is  with  the  alkaloids,  as  it  precipitates  practically  all  of 
them  in  the  form  of  tannates.  If  the  mixture  is  strongly 
alcoholic  no  precipitation  may  take  place,  as  the  tannates  of 
the  alkaloids  are  soluble  in  alcoholic  media.  Antipyrin  being 
of  the  nature  of  an  alkaloid,  tannic  acid  precipitates  it.  2.  It 
precipitates  some  glucosides  (digitalin)  and  some  neutral 
principles.  3.  It  precipitates  many  of  the  metals,  in  the  form 
of  a  tannate,  the  most  important  being  lead,  copper,  mer- 
cury and  silver.  4.  With  ammonia  and  potassium  hydroxide 
and  carbonate  it  gives  a  slight  precipitate.  5.,  With  lime 
water  it  gives  a  bluish-white  precipitate,  turning  darker. 
6.  With  ferric  salts  it  gives  a  bluish-black  or  green-black  solu- 
tion. 7.  With  ferrous  salts  It  is  supposed  to  give  a  white 
precipitate,  but  as  we  practically  never  see  ferrous  salts 
entirely  free  from  ferric  compounds,  the  result  is  that  with 
ferrous  salts  the  precipitate  is  also  dark. 

8.  It  decolorizes  a  solution  of  iodine  (unless  the  latter 
is  in  excess),  combining  with  it  to  form  various  compounds. 
That  there  is  a  true  chemical  reaction  between  iodine  and  tan- 
nic acid  is  seen  from  the  fact  that  the  former  does  not  color 
starch  blue  in  the  presence  of  the  latter.  9.  It  is  incompatible 
with  potassium  permanganate,  reducing  the  latter.  10.  With 
spirit  of  nitrous  ether,  there  is  evolution  of  gas,  probably 
various  oxides  of  nitrogen.  It  is  supposed  to  be  incompatible 
with  iodoform,  but  the  writer  doubts  it. 

All  tannin-containing  drugs  will  of  course  have  the  same 
incompatibilities  as  tannic  acid.  Drugs  containing  a  large 
amount  of  tannin  are:  krameria,  kino,  gambir,  hematoxylin, 
quercus,  rubus  and  wild  cherry. 

Aconitina.  Aconitine  should  best  be  administered  by  itself 
if  in  solution,  or  in  the  form  of  pills  or  granules.  It  is  not 
likely  to  be  prescribed  in  concentrated  solution,  and  in  dilute 


222          PRESCRIPTION  INCOMPATIBILITIES 

solution  it  is  precipitated  only  by  tannic  acid  and  mercuric- 
potassium  iodide  (also  gold  chloride). 

Aethylis  Carbamas.  Urethane.  Produces  a  liquid  or  moist 
mass  when  triturated  with  antipyrin,  benzoic  acid,  betanaph- 
thol,  camphor,  hydrated  chloral,  exalgin,  menthol,  resorcin, 
trional,  salol,  salicylic  acid,  thymol. 

Agurin.    See  Theobrominae  Sodio-Acetas. 

Alkaloids.  Great  care  is  necessary  in  prescribing  these,  be- 
cause most  of  them  being  potent  drugs,  precipitation  may 
cause  serious  consequences,  by  an  overdose  of  the  alkaloid 
being  poured  out  in  one  dose.  Whenever  feasible,  alkaloids 
should  be  prescribed  by  themselves,  either  in  solution  or  in 
the  form  of  granules,  pills,  etc.  Alkaloids  should  not  be  pre- 
scribed with:  Potassium  hydroxide,  carbonate  and  bicar- 
bonate ;  sodium  hydroxide,  carbonate,  bicarbonate  and  borate 
(also  phosphate)  ;  ammonia  water  and  ammonium  carbonate; 
lime-water,  iodides,  bromides,  tannic  acid  (or  substances  con- 
taining tannin);  mercuric  chloride;  gold  chloride.  Besides 
the  foregoing,  quinine  is  also  incompatible  with  salicylates  and 
acetates.  The  reason  the  alkaloids  are  incompatible  with  the 
above  enumerated  substances  is  because  the  alkaloids  are 
precipitated  by  them.  For  instance,  if  we  prescribe  morphine 
sulphate  and  ammonia  water  or  ammonium  carbonate  (or  the 
aromatic  spirit  of  ammonia,  which  contains  those  substances), 
pure  alkaloidal  morphine,  which  is  but  very  slightly  soluble, 
will  precipitate ;  if  we  prescribe  morphine  sulphate  and  tan- 
nic acid,  morphine  tannate  will  precipitate;  if  we  prescribe 
strychnine  sulphate  and  mercuric  chloride,  a  double  salt  of 
strychnine  and  mercury  will  precipitate,  etc. 

It  is  well  to  bear  in  mind  that,  as  a  general  rule,  which, 
however,  has  a  number  of  exceptions,  the  pure  alkaloids  are 
insoluble  or  very  slightly  soluble  in  water,  but  soluble  in  al- 
cohol, in  fixed  oils  and  in  oleic  acid.  It  is  just  vice  versa  with 
alkaloidal  salts. 

(N.  B.— The  alkaloids,  or  their  salts,  official  in  the  phar- 
macopeia, are:  Aconitine,  aethylmorphine,  apomorphine, 


ALPHABETICAL  SUMMARY  223 

atropine,  betaencaine,  caffeine,  cinchonidine,  cinchonine,  co- 
caine, codeine,  colchicine,  cotarnine,  diacetylmorphine, 
emetine,  homatropine,  hydrastine,  hydrastinine,  hyoscyamine, 
morphine,  pelletierine,  physostigmine,  pilocarpine,  quinine, 
scopolamine,  sparteine,  strychnine,  theobromine,  theophylline ; 
in  practice,  codeine  may  be  prescribed  with  alkalies,  because 
the  pure  alkaloid  is  itself  quite  soluble  in  water.) 

Aloinum.  Precipitated  by  tannic  acid;  but  as  aloin  is  al- 
most invariably  prescribed  in  pill  or  capsule  form,  it  is  hardly 
necessary  to  consider  its  alleged  incompatibilities. 

Alumen.  Alumini  et  Potassii  or  Alumini  et  Ammonii  Sul- 
phas. 1.  Alum  is  incompatible  with  the  alkaline  hydrates  and 
their  carbonates  and  lime  water,  aluminum  hydroxide  being 
precipitated.  2.  With  borax,  aluminum  borate  (and  some 
hydroxide)  being  precipitated.  It  has  all  the  incompatibili- 
ties of  the  soluble  sulphates. 

Alypin.  1.  This  local  anesthetic  being  in  the  nature  of  an 
alkaloid  is  precipitated  by  alkaline  hydroxides  and  carbonates 
and  by  most  of  the  alkaloidal  reagents  or  precipitants.  2.  As 
the  alypin  ordinarily  used  is  alypin  hydrochloride,  it  gives 
naturally  a  precipitate  with  silver  nitrate.  When  it  is  de- 
sired to  prescribe  alypin  with  silver  nitrate,  alypin  nitrate, 
which  is  also  obtainable,  should  be  ordered. 

Amyli  Nitris.  Amyl  Nitrite.  As  amyl  nitrite  is  now  dis- 
pensed exclusively  by  itself,  in  the  form  of  glass  pearls,  it  is 
useless  to  discuss  its  incompatibilities. 

Antipyrina.  1.  With  ferric  chloride  either  in  the  form  of 
solution  or  tincture  and  other  ferric  salts  antipyrine  gives 
a  deep-red  color.  (Not  with  the  solution  of  ferric  citro- 
chloride,  unless  a  mineral  acid  is  added).  2.  With  calomel, 
particularly  in  the  presence  of  moisture  and  of  sodium  bicar- 
bonate, a  small  part  of  the  calomel  is  converted  into  mercuric 
chloride.  3.  With  spirit  of  nitrous  ether  a  beautiful  green 
color  is  formed ;  if  the  spirit  is  neutral  in  reaction,  the  forma- 
tion of  the  color  is  delayed  and  the  addition  of  a  crystal  of 
potassium  bicarbonate  may  delay  reaction  for  several  days. 


224          PRESCRIPTION  INCOMPATIBILITIES 

This  green  compound  which  is  iso-nitroso-antipyrine,  is,  con- 
trary to  prevalent  belief,  hardly  if  at  all  poisonous.  4.  Rubbed 
with  hydrated  chloral,  phenol,  piperazine  or  sodium  salicy- 
late,  a  soft  mass  or  liquid  is  formed. 

Argenti  Nitras.  Silver  nitrate  is  a  delicate  chemical  and 
is  easily  decomposed  by  light  and  in  contact  with  organic 
matter.  It  should  always  be  kept  in  amber  colored  or  blue 
bottles.  It  is  best  prescribed  alone  dissolved  in  distilled 
and  freshly  boiled  water.  Its  principal  incompatibilities  are 
soluble  chlorides,  which  at  once  precipitate  silver  chloride, 
borax  (silver  borate  precipitating)  and  tannic  acid  (precipi- 
tate of  silver  tannate). 

Argonin.  Silver  Casein.  It  is  incompatible,  a  precipitate 
being  formed,  with :  silver  nitrate,  zinc  sulphate,  carbolic  acid, 
tannic  acid  and  lead  acetate. 

Aristol.     See  Thymolis  lodidum. 

Argyrol.  Incompatible  with  zinc  sulphate,  lead  acetate 
and  tannic  acid,  a  precipitate  being  formed. 

As  argyrol  stains  the  skin  and  linen  badly,  it  is  well  to 
know  that  the  stains  are  quickly  and  completely  removed  by 
a  solution  of  mercuric  chloride. 

Arseni  lodidum.  Arsenic  iodide  should  not  be  prescribed 
in  solution  with  alkaloidal  salts,  as  many  of  them  are  precipi- 
tated. 

Arseni  Trioxidum.  1.  Incompatible  with  dialyzed  iron  and 
some  other  ferric  salts,  due  to  the  formation  of  the  insoluble 
basic  ferric  arsenite.  2.  Incompatible  with  hypophosphites 
in  acid  solution  and  hypophosphorous  acid,  because  reduced 
to  metallic  arsenic.  3.  Said  to  be  incompatible  with  strych- 
nine salts,  precipitating  strychnine  arsenite. 

Asaprol.  Calcium  Beta-Naphthol  Sulphonate.  1.  Is  decom- 
posed by  mineral  acids,  beta-naphthol  being  precipitated. 
2.  With  solution  of  antipyrine  a  precipitate  is  formed. 

Auri  et  Sodii  Chloridum,  Gold  and  sodium  chloride  should 
best  be  prescribed  alone,  and  preferably  in  pill  form.  1.  It 
is  apt  to  precipitate  alkaloids,  but  such  precipitation  may 


ALPHABETICAL  SUMMARY  225 

be  prevented  by  the  addition  of  a  small  amount  of  sodium 
thiosulphate.  2.  It  is  incompatible  with  potassium  iodide. 
3.  It  is  incompatible,  being  reduced  to  the  metallic  state, 
with  potassium  arsenite,  mercurous  and  ferrous  salts,  many 
organic  substances;  also  reduced  by  light  and  heat,  and  by 
metallic  iron. 

Benzoates.  Soluble  benzoates  give  a  salmon-colored  pre- 
cipitate with  ferric  salts,  due  to  the  formation  of  ferric  ben- 
zoate.  They  are  incompatible,  in  aqueous  solution,  with  acids, 
because  the  latter  decompose  them,  liberating  benzoic  acid, 
the  crystals  of  which  float  about  in  the  mixture  (benzoic 
acid  being  but  slightly  soluble  in  water). 

Bicarbonates.  1.  All  bicarbonates  cause  an  effervescence 
with  acids,  with  the  liberation  of  carbon  dioxid.  2.  They 
precipitate  many  alkaloids,  particularly  in  concentrated  so- 
lution. 3.  When  a  solution  of  bicarbonate  is  heated  it  is  con- 
verted into  carbonate.  This  is  an  important  point  to  remem- 
ber, because  the  carbonates  of  potassium  and  sodium  are  much 
stronger  and  more  irritant  than  the  corresponding  bicar- 
bonates. 

Bichromates  (potassium)  and  Chromates  form  precipi. 
tates  with  salts  of  lead,  silver,  mercury  and  strontium.  Po- 
tassium bichromate  forms  precipitates  with  many  alkaloids. 
Great  care  should  be  taken  in  triturating  bichromates  with 
sugar,  tannic  acid,  sulphur  and  other  easily  oxidizable  sub- 
stances. 

Bismuth!  et  Ammonii  Citras.  Incompatible  with  acids, 
the  latter  decomposing  the  double  salt,  and  bismuth  citrate, 
or  another  basic  salt  of  bismuth,  being  precipitated. 

Bismuth!  Subnitras.  1.  With  carbonates  and  bicarbonates 
in  solution,  carbon  dioxide  is  liberated,  due  to  the  liberation 
of  some  nitric  acid  from  the  subnitrate.  2.  Potassium  iodide 
and  other  iodides  convert  it  into  the  yellow  to  red  bismuth 
iodide.  3.  With  sodium  salicylate  it  is  said  to  form  bismuth 
salicylate.  We  have  not  found  this  to  be  the  case.  A  mixture 
of  bismuth  subnitrate  and  sodium  salicylate  in  water  remains 


226          PRESCRIPTION  INCOMPATIBILITIES 

unchanged  for  a  long  time.  4.  With  an  aqueous  solution  of 
tannic  acid  it  gradually  forms  the  yellow  tannate  of  bismuth. 
5.  The  same  is  true  of  gallic  acid. 

Caffeina.  It  is  well  to  know  that  the  solubility  of  caffeine 
and  its  salts  is  increased  by  the  presence  of  sodium  salicylate, 
sodium  benzoate  and  antipyrine.  It  is  for  this  reason  that  for 
hypodermic  and  intravenous  injections  we  generally  use 
"double"  salts  of  caffeine,  such  as  caffeine-sodium  salicylate. 

Calcmm-Betanaphthol  Sulphonate.     See  Asaprol. 

Calx  Sulphurata.  Sulphurated  lime  is  incompatible  with 
mineral  acids,  which  decompose  it,  forming  hydrogen  sul- 
phide, etc. 

Camphora.  1.  Camphor  forms  a  liquid  or  soft  mass  when 
triturated  with  chloral,  phenol,  guaiacol  carbonate,  betol,  an- 
tipyrine or  thymol.  2.  Water  added  to  an  alcoholic  solution 
of  camphor  (spirit  of  camphor)  throws  the  camphor  out  of 
solution.  3.  A  strong  solution  of  a  salt,  such  as  potassium 
bromide,  in  camphor  water,  will  throw  the  camphor  out  of 
solution. 

Camphora  Monobromata.  Monobromated  camphor  forms  a 
liquid  or  soft  mass  when  triturated  with  chloral,  phenol,  salol 
or  thymol. 

Carbo.  Charcoal  is  best  not  prescribed  in  mixtures  con- 
taining alkaloids,  glucosides  or  tannic  acid,  as  it  is  apt  to 
precipitate  them. 

Carbonates.  1.  The  alkaline  carbonates  act  practically  as 
the  corresponding  hydroxides  in  precipitating  alkaloids,  etc. 
2.  They  give  an  effervescence  with  all  acids  (with  the  ex- 
ception of  hydrocyanic  acid)  with  the  liberation  of  carbon 
dioxide.  3.  They  form  precipitates  with  soluble  salts  of  mag- 
nesium, calcium,  barium,  strontium,  iron,  manganese,  silver, 
aluminum,  antimony,  copper  and  zinc. 

Chloralamide.    See  Chloralformamidum. 

Chloralformamidum.  Chloralamide.  Forms  a  soft  mass  if 
rubbed  with  antipyrine,  menthol  or  camphor. 

Chloralum  Hydratum.     Hydrated  Chloral.     Chloral  Hy- 


ALPHABETICAL  SUMMARY  227 

drate.  1.  When  rubbed  with  camphor  forms  a  thick,  clear 
liquid :  camphor-chloral.  2.  Forms  a  liquid  or  soft  mass  when 
triturated  with  any  of  the  following:  phenol,  guaiacol  car- 
bonate, quinine  sulphate,  trional,  agurin,  hedonal. 

Chloretone.  1.  Forms  a  liquid  or  soft  mass  if  triturated 
with  phenol,  menthol,  antipyrine  (also  exalgin  or  euphorin). 
2.  Said  to  be  decomposed  by  alkalies  and  acids. 

Chinosol.  Oxyquinolin  Sulphate.  1.  An  aqueous  solution 
gives  a  precipitate  with  alkaline  hydroxides  and  soap  solu- 
tion. 2.  Incompatible  with  mercuric  chloride. 

Chlorates.  1.  Chlorates  are  strong  oxidizers  and  should 
not  be  triturated  or  heated  with  any  oxidizable  substance, 
such  as  the  following:  charcoal,  sugar,  sulphur,  sulphides 
and  sulphites,  thiosulphates,  hypophosphites,  nitrites  (!),  re- 
duced iron,  iodine,  tannic  acid,  gallic  acid,  salicylic  acid, 
phenol,  starch,  lycopodium.  Nor  should  they  be  triturated  in 
the  dry  state  with  glycerin  and  honey;  in  the  presence  of 
water,  however,  the  mixture  is  quite  safe.  2.  When  hydro- 
chloric acid  is  added  to  a  chlorate,  free  chlorine  is  given  off 
and  a  number  of  oxides  of  chlorine  are  formed. 

Chromii  Trioxidum.  Chromic  Acid.  Absolutely  incompati- 
ble with  alcohol,  ether,  glycerin  and  other  organic  solvents, 
decomposition  taking  place  sometimes  with  dangerous  vio- 
lence (explosion).  Incompatible  with  hydrogen  dioxide. 

Citrophen.     See  Paraphenetidin  Citrate. 

Cocaina.  Aside  from  the  usual  alkaloidal  incompatibilities, 
it  is  well  to  know  that  an  ointment  of  yellow  mercuric  oxide 
and  cocaine  hydrochloride,  such  as  is  not  infrequently  pre- 
scribed for  inflamed  eyelids,  is  apt  to  be  more  irritating 
than  the  ointment  of  the  mercuric  oxide  alone,  without  the 
cocaine.  This  is  due  to  the  fact  that  the  cocaine  hydro- 
chloride  probably  forms  some  mercuric  chloride. 

Godeina.  1.  Codeine  is  precipitated  by  most  of  the  alka- 
loidal precipitants,  but  not  by  the  alkaline  carbonates  and 
bicarbonates.  2.  It  is  usually  stated  that  codeine  is  incompati- 
ble with  some  ammonium  salts,  such  as  ammonium  chloride, 


228          PRESCRIPTION  INCOMPATIBILITIES 

because  ammonia  is  liberated.  This  is  a  purely  theoretical 
incompatibility.  Ammonium  chloride  and  codeine  have  been 
prescribed  for  years,  in  tens  of  thousands  of  prescriptions, 
and  may  continue  to  be  prescribed  without  any  fear  or  appre- 
hension. 

Collodium.  1.  Of  course  collodium  must  not  be  mixed 
with  water,  as  the  gun-cotton  will  at  once  precipitate  from 
its  alcohol-ether  menstruum.  2.  Ammonia  water  also  gives 
a  precipitate.  3.  A  gelatinous  mass  is  formed  with  phenol 
and  with  an  excess  of  creosote.  4.  The  tincture  of  iodine  of 
the  present  pharmacopeias,  i.  e.,  one  that  contains  potassium 
iodide,  may  be  mixed  with  collodion  without  precipitation. 

Creosoti  Carbonas.  Creosotal.  Creosote  carbonate  is  sel- 
dom prescribed  with  ingredients  with  which  it  is  incompatible. 

Creosotum.  1.  Creosote  gives  a  bluish  or  violet-blue  color 
with  ferric  salts ;  the  color  changes  to  greenish  and  then  dirty 
brown;  usually,  unless  the  solutions  are  very  dilute,  there  is 
also  a  brown  precipitate.  2.  Forms  a  white  precipitate  with 
solution  of  lead  subacetate.  3.  If  present  in  considerable  ex- 
cess forms  a  gelatinous  mass  with  collodion. 

Diacetylmorphinae  Hydrochloridum.  Heroin  Hydrochlo- 
ride.  Heroin  being  an  alkaloid  has  the  usual  alkaloidal  in- 
compatibilities. It  is  stated  that  both  alkalies  and  acids  read- 
ily convert  it  into  morphine. 

Diuretin.    See  Theobrominae  Sodio-Salicylas. 

Epinephrin.  Adrenalin,  Suprarenalin,  Suprarenin,  Supra- 
capsulin,  Adnephrin.  Epinephrin  is  one  of  those  substances 
that  are  best  prescribed  alone.  It  gets  readily  decomposed 
and  worthless  in  the  presence  of  oxidizing  agents.  It  should 
not  be  prescribed  with  silver  nitrate,  mercuric  chloride,  hy- 
drogen dioxide,  etc.  Whenever  a  solution  of  adrenalin  has 
acquired  a  brown,  red,  or  even  pink  color,  it  has  become 
deteriorated  and  should  be  discarded. 

Exalgin.  Methyl  Acetanilid.  Forms  a  soft  mass  when 
rubbed  with  phenol,  menthol,  hydrated  chloral,  resorcin, 
salicylic  acid 


ALPHABETICAL  SUMMARY  229 

Ferric  Salts.  1.  Alkaline  hydroxides  and  carbonates  cause 
a  red-brown  precipitate  of  ferric  hydroxide.  2.  Sodium  bo- 
rate  gives  a  precipitate  of  ferric  borate.  3.  Alkali  phosphates 
give  a  precipitate  of  ferric  phosphate,  largely  or  entirely  pre- 
vented by  the  presence  of  sodium  or  potassium  citrate  or 
tartrate.  4.  Potassium  or  sodium  hypophosphite  gives  a  pre- 
cipitate of  ferric  hypophosphite.  5.  Tannic  acid  gives  a  black 
color  and  precipitate,  and  this  is  true  of  all  vegetable  drugs 
which  contain  tannic  acid.  6.  Gallic  acid  gives  a  bluish  black 
color.  7.  Soluble  acetates  (potassium,  sodium,  ammonium) 
form  a  deep  red  color,  but  no  precipitate,  with  ferric  salts, 
due  to  the  formation  of  ferric  acetate.  Acetic  acid  does  not 
produce  a  red  color  with  ferric  salts.  8.  Soluble  benzoates 
give  a  flesh  colored  precipitate.  9.  Salicylates  give  a  deep 
violet  color,  and  in  concentration  a  violet  precipitate  of  ferric 
salicylate.  10.  Arsenites  and  arsenates  give  a  precipitate 
of  ferric  arsenite  and  arsenate.  11.  A  solution  of  phenol, 
creosote  or  guaiacol  gives  a  violet  blue  color.  12.  Anti- 
pyrine  gives  a  deep  red  color.  So  does  phenacetin.  Acet- 
anilid  gives  a  red  color  only  in  alcoholic  solution.  13.  Resor- 
cin  gives  a  dirty  violet  color.  14.  Salol  being  a  salicylate 
gives  a  violet  color  if  dissolved  in  alcohol.  So  does  oil  of 
wintergreen  and  oil  of  sweet  birch,  both  being  chemically 
methyl  salicylate.  15.  A  number  of  volatile  oils,  such  as  oils 
of  cinnamon,  cloves,  pimenta,  thyme,  give  a  blue,  green  or 
brown  color.  16.  With  mucilage  of  acacia  ferric  salts  form 
a  gelatinous  mass.  17.  Ferric  salts,  particularly  ferric  chlor- 
ide, liberates  iodine  from  iodides,  and  bromine  from  bromides. 
18.  It  is  well  to  bear  in  mind  that  syrup  and  glycerin  prevent 
or  retard  some  of  the  reactions  enumerated  above. 

Ferri  Phosphas  (Solubilis).  1.  The  soluble  ferric  phosphate 
is  incompatible  with  mineral  acids  which  precipitate  ferric 
phosphate  (the  insoluble  form)  ;  the  only  exception  is  glacial 
phosphoric  or  metaphosphoric  acid  free  from  orthophosphoric 
acid;  this  does  not  cause  a  precipitate.  2.  Potassium  and 


230          PRESCRIPTION  INCOMPATIBILITIES 

sodium  hydroxide  (but  not  ammonium  hydroxide)  cause  a 
precipitate  of  ferric  hydroxide. 

Ferri  Pyrophosphas  (Solubilis).  Everything  said  about 
ferric  phosphate  applies  to  ferric  pyrophosphate. 

Ferrous  Salts.  There  are  but  two  ferrous  salts  official,  the 
saccharated  carbonate  and  the  sulphate;  the  first  is  always 
prescribed  in  the  dry  state  (in  the  form  of  powders,  pills  or 
capsules)  and  the  second  almost  always ;  so  the  probability  of 
coming  across  any  incompatibles  of  ferrous  salts  is  very  re- 
mote. 

Ferrum.  Metallic  Iron.  Reduced  Iron.  Reduced  Iron 
must  not  be  triturated  with  potassium  permanganate  or  potas- 
sium chlorate;  while  the  danger  of  an  explosion  is  rather  re- 
mote, still  under  certain  circumstances  it  may  occur. 

Fluidextracta.  Most  fluid  extracts  being  made  with  alcohol 
and  containing  resinous  or  other  extractive  matters  give  a 
precipitate  when  mixed  with  water. 

Glucosides.  Many  glucosides  are  precipitated  by  tannic 
acid,  and  are  as  a  rule  decomposed  by  acids  and  alkalies. 

Glycerinum.  1.  Glycerin  is  absolutely  incompatible  with 
potassium  permanganate  and  chromic  acid.  2.  With  sodium 
borate  a  complex  reaction  occurs,  glycerol  borate  and  sodium 
metaborate  being  formed  (or,  as  it  is  claimed  by  some,  sodium 
glyceryl  borate  and  glyceroboric  acid),  but  for  all  that  the 
two  are  not  incompatible  and  may  be  safely  prescribed  to- 
gether. 

Glyceritum  Boroglycerini.  The  boric  acid  is  in  chemical 
combination  with  the  glycerin,  probably  in  the  form  of  glyceryl 
borate;  on  mixing  it  with  water  it  is  decomposed,  and  the 
liberated  boric  acid  may  precipitate  out,  if  there  is  not  suf- 
ficient water  to  hold  it  in  solution. 

Glycerophosphates.  The  only  real  incompatibility  of  the 
glycerophosphates  are  the  mineral  acids,  which  decompose 
them  with  the  liberation  of  glycerophosphoric  acid.  The  so- 
dium glycerophosphate  and  the  potassium  glycerophosphate 
are  very  deliquescent  and  cannot  be  prescribed  in  powder  or 


ALPHABETICAL  SUMMARY  231 

capsule  form.     Calcium  glycerophosphate  is  not  deliquescent. 

Glycyrrhizinum  Ammoniatum.  This  is  decomposed  by 
mineral  acids,  glycyrrhizic  acid  precipitating,  and  the  sweet 
taste  being  changed  to  bitter.  It  should  therefore  never  be 
prescribed  with  sulphuric  acid,  hydrochloric  acid,  etc. 

Guaiacolis  Benzoas.  Benzosol.  Decomposed  by  alkaline 
hydroxides  into  guaiacol  and  a  benzoate  of  the  alkali. 

Guaiacolis  Carbonas.  Duotal.  1.  Forms  a  soft  mass  when 
rubbed  with  chloral  hydrate.  2.  Like  other  guaiacol  salts  it 
is  decomposed  by  alkali  hydroxides,  being  split  into  guaiacol 
and  a  carbonate  of  the  alkali. 

Guaiacolis  Salicylas.  Decomposed  by  alkaline  hydroxides 
into  guaiacol  and  a  salicylate  of  the  alkali. 

Guaiacolum.  The  incompatibilities  are  practically  those  of 
creosote. 

Heroin.     See  Diacetylmorphine. 

Hexamethylenamina.  Urotropin,  Formin,  Aminoform, 
Cystogen.  Though  this  drug  is  prescribed  in  enormous 
amounts,  still  we  know  of  no  drugs  with  which  it  is  incompati- 
ble. It  is  claimed  that  it  is  decomposed  by  hot  water,  but  we 
are  not  sure  even  of  this  statement.  We  have  been  ordering 
it  dissolved  in  hot  water  for  a  great  many  years,  and  the  drug 
does  not  seem  to  be  injured  thereby.  The  only  thing  we  want 
to  caution  the  patient  about  is  to  take  the  hexa  dissolved  in  or 
followed  by  a  large  amount  of  water,  as  otherwise  it  may  prove 
irritating  to  the  stomach. 

Holocainae  Hydrochloridum.  Being  an  alkaloid,  it  has  the 
incompatibilities  of  all  alkaloids. 

Homatropina.  Being  an  alkaloid  it  has  the  incompatibil- 
ities of  all  alkaloids,  and  particularly  of  atropine. 

Hydrargyrum  Ammoniatum  is  decomposed  by  potassium, 
sodium  or  calcium  hydroxide,  ammonia  being  set  free  and  the 
yellow  mercuroxyammonium  chloride  being  formed. 

Hydrargyri  Chloridum  Corrosivum.  Corrosive  sublimate 
has  many  incompatibilities.  1.  It  might  not  incorrectly  be 
stated  that  it  is  incompatible  to  a  certain  extent  with  water, 


232          PRESCRIPTION  INCOMPATIBILITIES 

because  an  aqueous  solution  of  it  is  gradually  decomposed, 
being  partly  changed  into  calomel.  Ammonium  chloride  pre- 
vents this  change  and  for  this  reason,  corrosive  sublimate 
tablets  are  generally  made  to  contain  some  ammonium  chloride. 
Hydrochloric,  citric  or  tartaric  acid  also  prevents  the  change. 
2.  The  salt  with  which  mercuric  chloride  is  most  frequently 
prescribed  is  potassium  iodide.  Strictly  speaking  the  com- 
bination is  incompatible,  because  red  mercuric  iodide  is 
formed,  but  this  salt  quickly  dissolves  in  the  excess  of  potas- 
sium iodide,  the  double  salt,  potassio-mercuric  iodide,  being 
formed;  and  from  a  practical,  therapeutic  point  of  view  the 
combination  is  unobjectionable.  3.  It  is  incompatible  with  the 
hypophosphites  as  they  reduce  the  corrosive  sublimate  to 
calomel,  and  eventually  to  metallic  mercury.  4.  Incompati- 
ble with  arsenites,  which  reduce  it  to  calomel  and  then  to 
metallic  mercury.  5.  It  is  incompatible  with,  because  it  pre- 
cipitates, most  alkaloidal  salts.  6.  It  is  incompatible  with  lime 
water  and  with  potassium  -and  sodium  hydroxide  which  pre- 
cipitate it  as  mercuric  oxide  or  mercuric  oxychloride.  7.  Am- 
monia water  and  ammonium  carbonate  precipitate  it  as 
ammoniated  mercury  or  mercuric  ammonium  chloride.  8. 
Potassium  carbonate  or  sodium  carbonate  gives  a  precipitate, 
consisting  of  a  mixture  of  mercuric  oxychloride  and  mercuric 
oxide.  9.  Potassium  bicarbonate  or  sodium  bicarbonate  also 
gives  a  precipitate,  first  white,  then  turning  to  red,  of  various 
oxychlorides  of  mercury,  with  a  slight  effervescence.  10.  It  is 
incompatible  with  borax  which  precipitates  it  as  mercuric 
oxychloride,  of  a  reddish  brown  color. 

Hydrargyri  Chloridum  Mite.  1.  As  calomel  and  iodoform 
are  frequently  prescribed  together,  it  is  well  to  know  that  a 
chemical  combination  takes  place  between  the  two,  particularly 
in  the  presence  of  moisture,  some  red  mercuric  iodide  being 
formed.  This  is  also  true  of  other  compounds  containing 
iodine,  such  as  aristol,  airol  and  europhen.  2.  Calomel  should 
not  be  prescribed  with  cocaine  or  cocaine  hydrochloride  in  eye 
salves,  as  a  small  amount  of  mercuric  chloride  is  formed  which 


ALPHABETICAL  SUMMARY  233 

may  prove  irritating  to  the  eye.  3.  The  incompatibility  of 
calomel  with  sodium  bicarbonate  is  a  myth,  and  the  physician 
need  have  no  hesitation  in  prescribing,  nor  the  pharmacist  in 
dispensing,  this  combination.  4.  It  is  incompatible  with  the 
hydroxides  of  potassium  sodium,  potassium  and  calcium  which 
convert  it  into  the  black  mercurous  oxide  ("Black  Wash"). 
5.  Sodium  and  potassium  carbonates  convert  it  into  mercurous 
oxide  and  carbonate.  6.  Ammonia  water  and  ammonium  car- 
bonate convert  it  into  black  mercurous  ammonium  chloride. 
7.  Soluble  iodides  (as  well  as  soluble  bromides)  convert 
calomel,  in  the  presence  of  moisture,  into  mercurous  iodide  (or 
bromide),  which  is  apt  to  become  further  decomposed  into 
mercuric  iodide  (or  bromide)  and  metallic  mercury.  8.  Con- 
trary to  the  prevalent  belief  calomel  is  not  incompatible  with 
sodium  chloride  or  hydrochloric  acid.  9.  It  is  not  advisable 
to  prescribe  iodine  and  calomel  in  the  same  ointment,  as 
mercuric  iodide  may  form,  which  is  very  irritating. 

Hydrargyri  lodidum  Flavum.  Mercurous  iodide  is  in- 
compatible with  iodides,  becoming  decomposed  into  the  more 
toxic  mercuric  iodide  and  metallic  mercury. 

Hydrargyri  lodidum  Rubrum.  The  red  mercuric  iodide 
which  is  only  slightly  soluble  in  water  is  very  soluble  in  the 
presence  of  a  soluble  iodide  with  which  it  forms  a  double  salt. 
It  is  therefore  often  prescribed  in  combination  with  potassium 
iodide. 

Hydrargyri  Salicylas.  This  practically  insoluble  salt  dis- 
solves in  a  solution  of  sodium  chloride,  also  in  a  solution  of 
the  chlorides,  iodides  and  bromides  of  the  other  alkalies.  And 
a  solution  of  it  in  physiologic  salt  solution  is  used  for  hypo- 
dermic injections. 

Hyoscyamina.  The  alkaloid  hyoscyamine,  contrary  to  other 
alkaloids,  is  not  precipitated  by  potassium  or  sodium  bicarbo- 
nate; you  need  therefore  have  no  hesitation  in  prescribing 
fluidextract  of  hyoscyamus  in  combination  with  potassium  bi- 
carbonate, as  is  so  often  done  in  cystitis  and  in  acute 
gonorrhea. 


234         PRESCRIPTION  INCOMPATIBILITIES 

Ichthyol.  1.  Ichthyol  is  chemically  ammonium  sulphich- 
thyolate,  and  is  decomposed  by  acids,  the  sulphichthyolic  or 
ichthyolsul phonic  acid  precipitating  in  the  form  of  a  sticky 
mass.  2.  It  gives  a  precipitate  with  potassium  iodide,  potas- 
sium bromide,  zinc  sulphate,  and  alum.  These  are  really  the 
only  incompatibilities  of  any  practical  importance.  The  other 
so  called  incompatibilities  are  only  such  in  theory  and  need  not 
be  taken  into  account. 

lodoformum.  1.  lodoform  mixed  with  calomel  may  under 
certain  circumstances  (exposure  to  light)  enter  into  chemical 
action  and  form  some  mercuric  iodide.  2.  It  is  perhaps  slowly 
decomposed  and  also  deodorized  by  tannic  acid.  3.  It  is  not 
incompatible  with  Balsam  of  Peru,  statements  to  the  contrary 
notwithstanding. 

lodum.  Iodine  is  prescribed  practically  in  two  forms  only : 
that  of  the  tincture  and  that  of  the  ointment.  The  tincture 
of  the  present  pharmacopeia  contains  potassium  iodide  and  is 
therefore  readily  miscible  with  water,  which  was  not  the  case 
with  the  tincture  of  iodine  of  the  old  pharmacopeias.  The 
tincture  has  few  incompatibilities.  1.  It  is  best  to  be  careful 
about  mixing  it  with  ammonia  water,  as  there  is  a  possibility 
— a  slight  one — of  "iodide  of  nitrogen"  being  formed,  which 
when  in  the  dry  state  is  highly  explosive.  2.  With  metallic 
mercury  iodine  combines  to  form  first  mercurous  and  then 
mercuric  iodide.  This  is  a  point  of  practical  importance, 
because  doctors  often  prescribe  ung.  iodi  and  ung.  hydrargyri 
in  the  same  prescription,  and  such  an  ointment  sometimes 
proves  highly  irritating  and  burning,  due  to  the  formation 
of  mercuric  iodide.  3.  Iodine  when  added  to  oil  of  turpentine 
occasionally  causes  a  violent  reaction.  4.  Tincture  of  iodine 
or  Lugol's  solution  precipitates  most  alkaloids. 

Lactophenin.  Phenetidin  Lactate.  Incompatible  with,  be- 
cause decomposed  by,  acids  and  alkalies. 

Liquor  Arseni  et  Hydrargyri  lodidi.  Donovan's  Solution. 
This  double  iodide  solution  precipitates  nearly  all  alkaloids. 

Liquor  Calcis.    Lime  water.    Absorbs  carbon  dioxide  from 


ALPHABETICAL  SUMMARY  235 

the  air,  forming  calcium  carbonate  which  precipitates.  Should 
therefore  not  be  exposed  to  the  air.  Incompatible  with  numer- 
ous substances,  discussed  under  their  proper  headings. 

Liquor  Formaldehydi.  1.  Formaldehyde  is  incompatible 
with  hydrogen  dioxide  which  oxidizes  it  to  formic  acid.  Iodine 
is  claimed  to  do  the  same  thing.  2.  It  is  incompatible  with 
potassium  permanganate,  and  we  take  advantage  of  this  in- 
compatibility in  disinfecting  rooms  by  the  formaldehyde- 
permanganate  method.  3.  With  ammonia  formaldehyde  com- 
bines to  form  hexamethylenamine.  It  is  for  this  reason  that 
ammonia  water  is  an  efficient  antidote  in  poisoning  with 
formaldehyde. 

Liquor  Hydrogenii  Dioxidi.  While  hydrogen  dioxide  is  a 
strong  oxidizing  agent,  it  is  so  seldom  prescribed  in  combina- 
tion, that  its  importance  as  an  incompatible  factor  is  not  very 
great.  Many  of  the  statements  made  regarding  it  are  not  true. 
So  it  is  usually  stated  that  hydrogen  dioxide  converts  calomel 
into  mercuric  chloride ;  this  is  not  so ;  the  calomel  undergoes 
no  change.  A  few  points  are  important  to  bear  in  mind.  1.  It 
is  absolutely  incompatible  with  potassium  permanganate.  2. 
It  is  incompatible  with  carbolic  acid.  3.  Incompatible  with 
formaldehyde.  4.  Its  incompatibility  with  glycerin  is  myth- 
ical. The  two  may  very  well  be  prescribed  together. 

Liquor  Plumbi  Subacetatis.  1.  With  mucilage  of  acacia  it 
forms  a  thick  gelatinous  mass, — if  concentrated ;  if  diluted, 
stringy  pieces  are  formed.  Lead  acetate  does  not  form  a  pre- 
cipitate with  mucilage  of  acacia.  2.  Forms  a  precipitate  with 
a  strong  solution  of  phenol. 

Liquor  Potassii  Arsenitis.  Besides  the  incompatibilities  of 
arsenites,  Fowler's  solution  is  incompatible  with  alkaloids, 
because  it  contains  some  potassium  bicarbonate  (and  car- 
bonate). 

Lithium  Salts.  The  only  incompatibilities  of  practical  im- 
portance of  the  lithium  salts  are  potassium,  sodium  and  am- 
monium carbonate  and  phosphate.  They  give  a  precipitate  of 
lithium  carbonate  and  lithium  phosphate. 


236          PRESCRIPTION  INCOMPATIBILITIES 

Magnesium  Salts.  The  soluble  magnesium  salts,  particu- 
larly in  concentrated  solution,  are  precipitated  by  the  alkaline 
hydroxides  (as  magnesium  hydroxide)  ;  by  the  alkaline  car- 
bonates (as  basic  magnesium  carbonate)  and  by  alkaline  phos- 
phates (as  magnesium  phosphate). 

Mel.  Honey  is  supposed  to  decompose  borax  with  the  liber- 
ation of  boric  acid,  but  this  is  no  incompatibility,  but  an  ad- 
vantage, and  while  the  well-known,  old  time  preparation  of 
mel  boracis — honey  with  borax — is  becoming  obsolete,  there  is 
no  harm  in  it,  and  there  should  of  course  be  no  hesitation  in 
dispensing  it. 

Menthol.  1.  When  menthol  is  triturated  with  camphor, 
thymol,  hydrated  chloral  or  resorcin,  the  mixture  becomes 
liquid.  2.  When  water  is  added  to  an  alcoholic  solution  of 
menthol,  the  menthol  separates  out  in  the  form  of  oily  drops. 

Methylis  Salicylas.  Methyl  salicylate,  or  oil  of  sweet  birch 
or  artificial  oil  of  wintergreen,  gives  a  deep  violet  color  with 
ferric  salts. 

Morphina.  1.  Besides  the  general  incompatibilities  of  al- 
kaloids, morphine  gives  a  blue,  changing  to  dirty  green,  color 
with  ferric  chloride  in  neutral  aqueous  solution.  Acid  or 
alcohol  prevents  this  color  reaction.  2.  It  gives  a  yellowish 
color  with  spirit  of  nitrous  ether.  3.  It  is  claimed  to  be 
oxidized  by  chlorates. 

Novocaine.  Novocaine  being  an  alkaloid,  its  salts  are  pre- 
cipitated, like  other  alkaloidal  salts,  by  alkaline  hydroxides, 
carbonates,  etc. 

Olea  Fixa.  Fixed  or  Fatty  Oils.  1.  The  usual  error  of  the 
inexperienced  druggist  is  that  fixed  oils  are  readily  soluble  in 
or  miscible  with  glycerin.  They  are  not.  Nor  are  they  soluble 
in  alcohol,  the  only  exceptions  being  castor  oil  and  croton  oil. 
2.  With  alkaline  hydroxides  fixed  oils  combine  and  form  soaps 
or  emulsion-like  mixtures.  This  is  taken  advantage  of  in  a 
number  of  pharmaceutical  preparations. 

Olea  Volatilia.  Volatile  or  Essential  Oils.  Volatile  oils  are 
soluble  in  alcohol  and  only  to  a  slight  extent  in  water.  When 


ALPHABETICAL  SUMMARY  237 

water  is  added  to  an  alcoholic  solution  of  a  volatile  oil,  the 
latter  therefore  separates  out  and  a  turbidity  or  milkiness  is 
produced. — Oil  of  cloves  gives  a  green  color  with  tincture  of 
ferric  chloride.  Oil  of  cinnamon  gives  a  brown  color. 

Opium.  1.  On  account  of  the  morphine  and  the  meconic 
acid  which  it  contains,  tincture  of  opium  gives  a  red  color 
with  solution  of  ferric  chloride.  With  tincture  of  iron  the 
reaction  is  not  pronounced.  2.  Tincture  of  opium  contains 
numerous  alkaloids  which  are  thrown  out  of  solution  by  most 
of  the  alkaloidal  precipitants.  3.  The  well  known  lead  and 
opium  wash — Lotio  Plumbi  et  Opii — is  an  incompatible  com- 
bination. Nevertheless  it  will  continue  to  be  prescribed,  be- 
cause physicians  claim  good  results  from  it  in  various  inflam- 
matory conditions,  in  bruises  and  in  sprains. 

Oxidizing  Agents.  In  studying  incompatibilities,  we  often 
come  across  the  term  "oxidizing  agents."  Oxidizing  agents 
are  chemicals  that  more  or  less  readily  give  up  their  excess  of 
oxygen  to  substances  which  readily  combine  with  that  oxygen, 
in  other  words,  are  readily  oxidized.  The  most  important 
oxidizing  substances  from  a  practical  point  of  view  are  chlo- 
rates, permanganates,  nitrates  (chromates),  also  chromic,  nitric 
and  nitrohydrochloric  acids.  These  chemicals  should  not  be 
mixed,  or  only  very  carefully,  with  sulphur,  charcoal,  hypo- 
phosphites,  tannic  acid,  glycerin,  honey,  starch,  sugar  and 
vegetable  powders  in  general. 

Pancreatinum.  Pancreatin  in  aqueous  solution  is  precipi- 
tated by  strong  alcohol  and  mineral  acids,  and  its  value  is 
diminished — so  it  is  generally  held — by  contact  with  those 
substances,  as  well  as  in  the  presence  of  pepsin. 

Paraldehydum.  It  is  claimed  that  paraldehyde  is  incom- 
patible with  iodides,  because  it  decomposes  them  with  the  liber- 
ation of  iodine. 

Paraphenetidin  Citrate.  Citrophen.  Gives  a  red  color  with 
ferric  salts. 

Piperazina.  1.  All  that  it  is  really  necessary  to  remember 
about  piperazine  is  that  it  is  strongly  alkaline  and  that  it 


238          PRESCRIPTION  INCOMPATIBILITIES 

should  therefore  not  be  prescribed  with  alkaloids,  as  it  would 
cause  their  precipitation.  2.  As  piperazine  is  hygroscopic  it 
should  not  be  prescribed  in  powder  form.  3.  Particularly 
with  acetanilid  or  antipyrine  it  is  apt  to  form  a  liquid  or  soft 
mass. 

Pepsinum.  Pepsin  is  considered  incompatible  with  alkalies, 
alcohol,  and  hydrochloric  acid  of  a  higher  concentration  than 
0.5  per  cent.  All  those  substances  on  prolonged  contact  are 
supposed  to  destroy  its  digestive  activity. 

Peroxida.  Peroxides  are  incompatible  with  acids  which  de- 
compose them  with  the  liberation  of  hydrogen  peroxide.  When 
dissolved  in  water,  the  same  reaction  takes  place,  only  more 
slowly. 

Petrolatum.  1.  Petrolatum,  liquid  or  solid,  is  not  miscible 
with  glycerin,  water  or  alcohol ;  with  the  solid  petrolatum  small 
quantities  of  those  liquids  can  be  incorporated.  2.  In  incor- 
porating alkaloids  with  petrolatum  it  is  best  to  use  the  free 
alkaloids  instead  of  the  alkaloidal  salts,  because  the  former  are 
slightly  soluble  in  petrolatum,  but  not  the  latter. 

Phenocoll  Hydrochloride.  Phenocoll  is  alkaloidal  in  its 
character  and  has  the  general  incompatibilities  of  the  alkaloids. 

Phenol.  Carbolic  Acid.  Phenylic  Acid.  1.  Incompatible 
with  collodion,  forming  a  gelatinous  mass.  2.  Incompatible 
with  hydrogen  dioxide,  becoming  oxidized  to  pyrocatechin, 
hydroquinone,  etc.  3.  Incompatible  with  potassium  perman- 
ganate, becoming  oxidized  to  oxalic  acid  and  carbon  dioxide. 
4.  Incompatible  with  nitric  acid,  becoming  converted  into 
picric  acid.  5.  It  reduces  silver  salts.  6.  In  dilute  solution 
(1  per  cent.)  it  gives  a  violet  blue  color  with  ferric  salts. 
7.  Phenol  forms  a  liquid  or  a  soft  mass  when  triturated  with 
the  following  substances:  acetanilid,  antipyrin,  betanaphthol, 
camphor,  monobromated  camphor,  hydrated  chloral,  menthol, 
naphthalene,  pyrogallol,  resorcin,  salol  and  thymol. 

Remember  that  carbolic  ' '  acid ' '  is  not  an  acid,  and  will  not 
for  iiistance  liberate  C02  from  a  carbonate  or  a  bicarbonate. 

Phenylis  Salicylas.    Being  a  salicylate  it  has  the  incompat- 


ALPHABETICAL  SUMMARY  239 

ibilities  of  the  latter ;  but  it  generally  needs  first  to  be  dissolved 
in  an  alcoholic  menstruum,  before  it  develops  its  reaction.  It 
forms  a  liquid  or  soft  mass  when  triturated  with  antipyrin 
(damp  powder),  camphor,  monobromated  camphor,  chloral 
hydrate,  exalgin,  naphthalene,  phenol,  thymol  and  urethane. 

Plumbi  Acetas.  1.  Incompatible  with  potassium  and  sodium 
hydroxide  (lead  hydroxide),  potassium  and  sodium  carbonate 
(lead  carbonate),  borax  (lead  borate).  2.  Incompatible  with 
H2S04  or  soluble  sulphates,  with  HC1  or  soluble  chlorides, 
with  soluble  iodides,  bromides  and  phosphates.  3.  With  tan- 
nic  acid  and  pyrogallol.  4.  With  soluble  benzoates  and  sali- 
cylates.  5.  With  many  alkaloids.  6.  Both  on  account  of  chem- 
ical reaction  and  the  liberation  of  water  of  crystallization  it 
forms  a  soft  mass  when  rubbed  with  alum,  zinc  sulphate, 
phenol,  acetanilid  or  salicylic  acid. 

Potassii  Permanganas.  Potassium  permanganate  belongs 
to  those  few  substances  in  medicine  which  should  always  be 
prescribed  alone,  if  ordered  in  aqueous  solution.  It  is  very 
easily  acted  upon  by  a  large  number  of  chemicals,  and  prac- 
tically by  all  organic  substances,  and  it  is  particularly  the 
latter  that  must  be  avoided.  1.  It  is  incompatible  with  hy- 
drogen dioxide,  a  very  complex  reaction  taking  place,  with  the 
result  that  both  the  permanganate  and  the  dioxide  are  de- 
stroyed. 2.  It  is  absolutely  incompatible  with  glycerin,  alco- 
hol and  carbolic  acid.  3.  It  should  never  be  triturated,  as  an 
explosion  may  result,  with  sulphur,  charcoal,  sugar,  tannic 
acid,  picric  acid  or  other  organic  substances. 

Potassii  et  Sodii  Tartras.  Rochelle  Salt.  Practically  all 
acids  decompose  it,  combining  with  the  sodium  radical  and 
potassium  bitartrate  (cream  of  tartar)  precipitating. 

Protargol.  1.  Protargol  in  solution  is  precipitated  by  zinc 
sulphate,  lead  acetate,  mercuric  chloride,  alum,  and  silver 
nitrate.  2.  It  is  best  never  to  prescribe  it  with  alkaloids,  as  a 
precipitate  is  apt  to  occur.  3.  The  addition  of  glycerin  to 
protargol  is  reprehensible,  as  a  protargol  solution  containing 
glycerin  is  more  irritating  than  a  pure  aqueous  solution.  4. 


240          PRESCRIPTION  INCOMPATIBILITIES 

Being  an  organic  compound,  protargol  is  incompatible  with 
potassium  permanganate. 

Pyramidon.  1.  Gives  a  blue  and  violet  color  with  spirit  of 
nitrous  ether.  2.  With  a  solution  of  quinine  bisulphate  it 
gives  a  white  precipitate.  3.  If  triturated  with  hydrated 
chloral  it  forms  a  soft  mass. 

Pyrogallol.  1.  Gives  a  purple  color  with  lime  water,  which 
changes  to  dirty  brown.  2.  Gives  a  white  precipitate  gradual- 
ly turning  dark  with  lead  acetate.  3.  Absolutely  incompati- 
ble with  potassium  permanganate.  4.  It  forms  a  liquid  or 
soft  mass  when  triturated  with  antipyrine,  camphor,  phenol 
or  menthol. 

Quinina.  1.  Solutions  of  quinine  salts  are  incompatible 
with,  because  precipitated  by,  soluble  acetates,  benzoates, 
salicylates,  and  tartrates.  The  corresponding  acids  do  not 
cause  a  precipitate.  2.  A  precipitate  is  also  said  to  be  given 
by  resorcin.  3.  Triturated  with  thymol  quinine  sulphate 
produces  a  soft  mass.  4.  Of  course  solutions  of  quinine  and 
its  salts  have  all  the  general  incompatibilities  of  alkaloids. 

Resorcinol.  1.  Resorcin  either  in  substance  or  in  solution 
turns  reddish,  then  dark  when  exposed  to  air  and  light.  2.  It 
precipitates  a  solution  of  quinine  sulphate  or  bisulphate.  3. 
When  triturated  with  acetanilid,  antipyrine,  camphor,  cam- 
phor monobromide,  phenol  or  menthol  it  forms  a  liquid  or  soft 
mass. 

Salol.    See  Phenylis  Salicylas. 

Saloquinine.  This  chemical  is  insoluble  in  water  but  soluble 
in  acids,  from  which  acid  solution  it  is  precipitated  by  alkaline 
hydroxides  and  carbonates  and  the  other  general  alkaloidal 
precipitants. 

Santonin.  Santonin  is  practically  insoluble  in  water,  but  is 
soluble  in  the  presence  of  alkalies,  combining  with  the  latter 
to  form  a  santoninate.  It  turns  yellow  on  exposure  to  light. 
An  aqueous  solution  of  sodium  santoninate  or  any  other 
santoninate  is  precipitated  by  tannic  acid. 

Sapo.    Soap  is  generally  alkaline  and  when  prescribed,  as 


ALPHABETICAL  SUMMARY  241 

it  occasionally  is,  with  calomel,  it  converts  the  latter  into  the 
black  mercurous  oxide.  Soap  is  decomposed  by  mineral  acids, 
the  fatty  acids  being  liberated.  Metallic  salts  generally  de- 
compose a  solution  of  soap,  the  metallic  oleate  precipitating. 

Sodii  Boras.  Borax  is  alkaline  in  reaction  and  therefore 
tends  to  precipitate  the  alkaloids.  Glycerin  however  by  de- 
composing the  borax  (into  boric  acid  and  sodium  borate)  pre- 
vents this  precipitation.  As  just  stated,  glycerin  and  borax 
react  upon  one  another,  but  this  cannot  be  considered  an 
incompatibility. 

It  is  incompatible  with  mucilage  of  acacia,  producing  a  thick 
gelatinous  mass.  Syrup  prevents  this  precipitation.  Tritu- 
rated with  alum  it  forms  a  moist  powder  (due  to  the  liberation 
of  the  large  amount  of  water  of  crystallization). 

Sodii  Perboras.  When  sodium  perborate  is  dissolved  in 
water  hydrogen  dioxide  and  sodium  metaborate  are  formed. 

Sodii  Phosphas.  Being  slightly  alkaline  it  has  a  tendency 
to  precipitate  some  alkaloids.  When  triturated  with  anti- 
pyrin  or  sodium  salicylate,  the  powder  becomes  damp.  It,  of 
course,  has  the  incompatibilities  of  the  phosphates. 

Sodii  Thiosulphas.  (Sodium  Hyposulphite).  Incompatible 
with  all  acids,  sulphur  dioxide  being  evolved  and  sulphur  pre- 
cipitating. It  should  not  be  triturated  with  chlorates,  chro- 
mates,  nitrates  and  permanganates,  and  other  oxidizing  sub- 
stances, as  an  explosion  is  liable  to  take  place.  It  is  absolutely 
incompatible  with  sUver  and  mercury  salts,  reducing  them  to 
the  metallic  state  or  to  sulphides.  It  reduces  ferric  salts  to 
ferrous  compounds. 

Spiritus  Aetheris  Nitrosi.  Spirit  of  Nitrous  Ether.  Sweet 
Spirit  of  Niter.  This  is  an  important  substance  on  account  of 
its  many  incompatibilities  and  frequency  of  prescribing.  1.  It 
is  incompatible  with  antipyrin,  producing  iso-nitroso  antipyrin 
of  a  grass-green  color.  Though  this  compound  is  not  poison- 
ous, as  it  was  once  considered,  still  it  is  better  not  to  dispense 
antipyrin  with  spirit  of  nitrous  ether.  2.  With  acetanilid  it 
gives  a  yellow  solution.  3.  It  is  incompatible  with  bromides 


242          PRESCRIPTION  INCOMPATIBILITIES 

and  particularly  iodides,  liberating  bromine  and  iodine.  4. 
With  sodium  salicylate  the  mixture  acquires  a  dark  color.  5. 
With  tannic  acid  and  substances  containing  taiinic  acid,  such 
as  buchu,  uva  ursi,  there  is  quite  an  evolution  of  gas  (various 
oxides  of  nitrogen)  and  the  bottle  should  not  be  stoppered 
until  all  the  gas  has  escaped.  These  reactions  take  place  prin- 
cipally with  a  spirit  having  an  acid  reaction,  but  it  is  very  rare 
indeed  to  find  a  spirit  of  a  perfectly  neutral  reaction. 

Spiritus  Ammoniae  Aromaticus.  When  mixed  with  water 
or  aqueous  menstrua  turbidity  results,  due  to  the  separation 
of  the  oils.  It  has  all  the  incompatibilities  of  ammonia  water 
and  ammonium  carbonate. 

Spiritus  Glycerylis  Nitratis.  Nitroglycerin  is  so  seldom 
prescribed  with  other  drugs  that  there  is  no  occasion  to  con- 
sider its  incompatibilities.  In  fact  it  always  should  be  pre- 
scribed alone,  not  only  for  pharmaceutical  or  chemical,  but  for 
therapeutic  reasons. 

Strontium.  Strontium  salts  are  precipitated  by  alkaline 
hydroxides  and  carbonates,  soluble  phosphates,  sulphates, 
(chromates),  and  citrates. 

Strychnina.  See  Alkaloids.  Hydrochloric  acid  with  a  solu- 
tion of  strychnine  hydrochloride  is  said  to  give  a  precipitate. 
But  this  can  only  refer  to  the  strong  hydrochloric  acid,  and 
such  a  combination  is  not  likely  ever  to  be  met  with  in  practice. 

Sulphonethylmethanum.  Trional.  This  hypnotic  is  not 
likely  to  be  prescribed  with  substances  with  which  it  forms  in- 
compatible combinations.  One  might  remember  that  if  trit- 
urated with  hydrated  chloral  or  urethane  a  soft  mass  will  re- 
sult. 

Sulphonmethanum.  Sulphonal.  This  is  a  very  stable  sub- 
stance and  we  know  of  no  incompatibilities.  It  is  claimed  to 
liquefy  when  triturated  with  hydrated  chloral. 

Sulphur.  The  only  thing  in  incompatibilities  to  remember 
about  sulphur  is  not  to  triturate  it  with  a  strong  oxidizer,  such 
as  potassium  permanganate  or  potassium  chlorate.  An  ex- 
plosion may  occur. 


ALPHABETICAL  SUMMARY  243 

Theobrominae  Sodio-Acetas.  Agurin.  1.  Incompatible  with 
acids,  which  split  up  the  salt.  2.  Being  alkaline  it  is  apt  to 
precipitate  some  of  the  alkaloids  from  the  solutions  of  their 
salts. 

Theobrominae  Sodio-SaJicylas.  Diuretin.  1.  Absolutely 
incompatible  with  acids  which  split  up  the  salt.  2.  Being 
alkaline  it  is  apt  to  precipitate  some  of  the  alkaloids.  3.  Being 
a  salicylate  it  has  the  incompatibilities  of  a  salicylate. 

Thymol.  When  rubbed  with  acetanilid,  antipyrin,  camphor, 
monobromated  camphor,  carbolic  acid,  hydrated  chloral,  men- 
thol, salol,  or  quinine  sulphate,  thymol  forms  a  liquid  or  a  soft 
mass. 

Thymolis  lodidum.  Aristol.  1.  It  is  not  advisable  to 
triturate  it  strongly  with  calomel,  as  the  liberated  iodine  may 
convert  a  portion  of  the  calomel  into  mercuric  iodide.  2.  Con- 
trary to  careless  statements,  it  is  quite  compatible  with  starch. 

Tinctura  lodi.  The  old  pharmacopeial  tincture  would  give 
a  precipitate  when  mixed  with  water  or  aqueous  preparations. 
The  tincture  of  the  new  pharmacopeia,  however,  containing  as 
it  does  potassium  iodide,  is  perfectly  miscible  with  aqueous 
menstrua.  Of  course  the  tincture  has  the  incompatibilities  of 
iodine  and  potassium  iodide  (q.  v.),  modified  by  the  alcohol. 

Trinitrophenol.    See  Acidum  Picricum. 

Trional.    See  Sulphonethylmethanum. 

Urea.  It  is  not  likely  that  urea  will  be  prescribed  in  com- 
bination with  other  substances,  but  we  might  mention  that 
when  triturated  with  hydrated  chloral  it  produces  a  soft  mass 
or  a  liquid. 

Zinc  Salts.  Soluble  zinc  salts  are  incompatible  with  soluble 
hydroxides,  carbonates,  phosphates,  and  with  borax.  With 
tannic  acid  zinc  salts  give  a  precipitate  only  in  concentrated 
solution. 


INDEX 

Prescription  No. 

A  CACIA  4.  borax  +  syrup  -f  water    227 

**     -(-  borax  -f-  water  226 

Acidum  acetylsalicylicum  -(-  hexamethylenamine    228 

-j-  potass,  iodide   245 

Acidum  benzoicum  -f-  linie  water  266 

Acidum  boricum  -j-  sol.  lead  subacetate 92 

(excessive  quantity)  -f-  water  98 

Acidum  carbolicum.    See  Phenol. 

Acidum  chromicum  -\-  alcohol  50 

-f-  hydrogen  dioxide  163 

Acidum  citricum  -\-  sod.  salicylate  87 

Acidum  gallicum  -f-  ferrous  sulphate  -f-  copper  sulphate  -|-  zinc 

sulphate    267 

Acidum  hydr.  dilutum   247 

Acidum  hydrochloricum  dilutum -|- comp.  rhubarb  powder....  261 

-j-  potassium  chlorate 60 

-|-  sodium   sulphite   132 

Acidum  hydrocyan.  dil 255 

Acidum  nitrohydrochloricum  -}-  potassium  iodide   195 

Acidum  phenylcinchoninicum  -|-  hexamethylenamine  229 

Acidum  phosphoricum  dilutum  -f-  ferric  pyrophosphate 83 

Acidum  picricum  -(-  cocaine  hydrochlor 86 

Acidum  salicylicum    (excessive  quantity)    122 

-f-  calomel  -\-  lime   water    188 

-f  glycerin  -f  water    230,  251 

-j-  lime  water  187 

-|-  mass  of  ferrous  carbonate   323 

-j-  potassium  permanganate    184 

-j-  sod.  bicarbonate 69,    70 

-j-  tannic   ac.  -f-  alum  -f-  kaolin    373 

(excessive  quantity)  -\-  sod.   bicarbonate    220 

(excessive  quantity )  -f-  water   97 

245 


246  INDEX 

Prescription  No. 

Acidum  sulphuricum  arom.  -f-  comp.  chalk  powder  -f-  water. .  260 

Acidum  sulphurosum  -(-  hydrogen  peroxide   412 

Acidum  tannicum  -f-  alum  211 

-f-  argyrol   281 

-|-  bismuth   subnitrate    293 

-f-  copperas  -}-  alum    268 

-f-  morphine   sulphate    1 

-j-  potassium  chlorate 84 

-{-potassium  permanganate  85 

-(-  sol.  of  lime  (lime  water) 9 

-(-  zinc  sulph.  -f-  water 371 

Acetanilid  -j-  resorcin   257 

-|-  spir.  nitrous  ether 256 

-j-  thymol  -|-  resorcin  258 

Acetozone  -|-  water    259 

Acetphenetidinum  -f-  exalgin  319 

-j-  tr.  ferric  chloride 234 

Acidol.     See  Betainae  Hydrochl. 

Aconitinae  nitras  -(-  collodium   21 

Adrenalin  chlor.  -\-  silver  nitrate  240 

-f-  hydrogen  dioxide   317 

Adrenalin!   sol.  -[-  pinoleum    379 

Agurin  -f-  sod.  salicyl.  -j-  syr.  of  lemon 269 

-{-  sparteine  sulph.  -j-  syrup 366 

Airol  -|-  calomel  296 

-f-  calomel  -(-  lime    water    388 

Alcohol  -f-  chromic  acid   50 

Alkaloidal    salts  -f  olive    oil    96 

-f  petrolatum  350 

Alkaloids  -j-  mercauro    159 

-(-  mercuric  chloride  -|-  potassium  iodide 55,    56 

Alumen  -\-  borax  -j-  chloroform  water    270 

-f-  borax  -(-  glycerin  -|-  water    244 

-f-  copperas  -|-  tannic   acid    268 

-j-  lead  acetate 105,  106 

-j-  lead  acetate  (in  powders)    107 

-f-  lime   water    271 

-f-  sodium  borate   (in  powder) 357 

-f-  tannic  acid    211 


INDEX  247 

Prescription  No. 

Alypinum  -(-  Dobell's  solution   273 

-|-  silver  nitrate  272 

Ammonii  benzoas  -f  tr.  ferric  chloride   194 

Ammonii   carbonas  -j-  calomel    147 

-f-  morphine  sulphate 2 

-f-  quinin.   bisulphate    18 

-j-  syr.  ipecac 67 

-j-  syr.   squills    67 

Ammonii  chloridum  -J-  codeine  185 

Ammonium  sulpho-ichthyol.    See  Ichthyol. 

Amylum  -\-  europhen    385 

-j-  thymol  iodide    369 

Antikamnia  -(-  antipyrin  -|-  phenacetin  -|-  acetanilid  -{-  phenal- 

gin  -f-  caffeine   375 

-p  morph.  sulph.  -(-  quin.  sulph.  -f-  arom.  sulph.  ac 149 

Antim.  et  potass,  tartr.  -f-  tannic  ac.  (syr.  wild  cherry) 3 

Antipyrina  -\-  calomel    37 

-j-  calomel  -f-  sod.  bicarbon 157 

-j-  piperazin  in  powders 274 

-j-  resorcin  -f-  phenacetin    196 

-f-  salol  -j-  camphor    352 

-(-  sodium  salicylate   25 

-j-  spir.  nitrous  ether  24 

-(-  tannic  acid  (in  syr.  wild  cherry)   23 

-}-  tr.    ferric    chloride    65 

Aqua  ammoniac  -|-  collodion  137 

-(-  tr.   iodine  -(-  soaP   liniment    339 

Aqua  ammoniae  f  ortior  -f-  ether  -(-  collodion  -|-  tr.  iodine 138 

Aqua    camphorae  -|-  bromides    17 

Aqua  cinnamomi  -|-  tinct.  of  ferric  chloride 7 

Aqua  crotonis  -[-  magnes.  sulph 312 

Aqua  gaultheriae  -f  tr.  of  ferric  chloride 64 

Argenti  nitras  -f-  alypin  272 

-|-  ext.   glycyrr 45 

-j-  organic  substances  45,  46,    47 

-j-  organic  substances  (in  liquid  form)    204 

-j-  organic  substances   (in  powder  form) 203 

— (-  phenol    351 

-j-  potass,  permanganate  ... ... 154 


248  INDEX 

Prescription  No. 

-}-  powd.    althea    • 45 

-{-  protargol  -j-  lead   acetate 353 

-f-  sodium   borate    276 

-|-  sodium  chloride   48 

-j-  sol.  adrenalin  chlor.    240 

-{-  sol.  potass,  arsenite    77 

-(-  syr.   hypophosphites    20 

Argonin  -j-  tannic   acid    278 

-f-  zinc  sulphate 277 

-f-  zinc  sulph.  -f-  lead  acetate  -}-  bismuth  subnitrate 279 

Argyrol  -|-  mercuric  chloride  282 

+  iodine    207 

-f-  potassium  iodide    407 

-}-  tannie   acid    281 

-f-  zinc  sulphate  280 

Aristol.    See  Thymolis  lodidum 370 

Asaprol  -)-  nitrohydrochlor  ac 299 

Aspirin  -(-  formin.    See  also  Acidum  Acetyl  Salicylicum 228 

-(-  potass,    iodide    245 

-f-  quinine    sulphate    413 

-|-urotropin    228 

Atophan  -f-  urotropin  229 

Atropinae   sulphas  -f-  collodion    21 

(excessive  dose)    11 

-\-  potassium  iodide 11 

Auri  et  sodii  chloridum  -|-  sol.  potassium  arsenite 286 

F>  ALSAMUM  Peruvianum  -j-  hydrogen  dioxide 168 

-f  iodof onn  -f  lard  338 

Barii  sulph 313 

Betainae  hydrochloridum  -j-  pepsin   394 

Bismuthi  et  ammonii  citras  -|-  hydrochloric  acid  80 

-|-  hydrochlor.    acid  -f-  pepsin    291 

Bismuthi  salicylas  -|-  hydrochloric  acid 419 

-f-  mist,  rhei  et  sodae  420 

-{-  sodium  bicarbonate   420 

Bismuthi  subnitras  -(-  calcined  magnesia   181 

-f  potassium  iodide 292 

-j-  sod.  bicarbon 204 


INDEX  249 

Prescription  No. 

-f-  sodium  bicarbonate  41 

-j-  sod.  bicarbonate  (in  pill  form)    49 

-f  tannic  acid  -f-  syrup  -f  water  293 

Bismuthi  subsalicylas.    See  Bismuthi  Salicylas. 

-\-  nitrohydrochlor.  ac 298 

Brometone  -f-  pyramidon    539 

C*  AFFEINA  citr.  -|-  sodium  bromide  -f-  strontium  bromide. . .  294 

-j-  sodium  salicylate   406 

Caffeina  citrata  efferv.  — dispensed  in  paper  box 295 

Caffeinae-sodio  benzoas  -f-  dil.  hydrochlor.  ac.  -|-  pepsin 297 

Calcii  glycerinophosphas  -j-  potass,  glycerophos.  -J-  sod.  glycero- 

phos.  in  powders  265 

Calc.  chlor.  -J-  comp.  chalk  powder 314 

Calomel.     See  Hydrarg.  Chlor.  Mite. 

Calx  chlorinata  -J-  glycerin  -{-  water   383 

Calx  sulphurata   (in  powders)    300 

Camphora  (in  pills)   536 

-f  chloral    305 

-f-  chloral  -j-  phenol    306 

-j-  menthol   35 

-|-  menthol   (in  pills)    536 

-j-  phenol    302 

-|-  syr.  wild  cherry  -f-  water  537 

-j-  salol  -f-  antipyrin   352 

Camphora  monobrom  -|-  chloral  303 

Camphora  monobromata  -(-  chloral  -f-  lupulin 180 

Cannabis  indica  -|-  water 4 

Carbo  anim.  -j-  tr.  nux  vom.  -\-  comp.  tr.  cinchona 304 

Carbolic  acid.    See  Phenol. 

Chinosol  -\-  mercuric    chloride    308 

Chloralum  hydratum  -\-  camphor   303,  305 

-}-  camphor  -|-  phenol 306 

-f  sulphonal    365 

-}-  trional    363 

-f-  monobrom.   camphor  -(-  lupulin    180 

Chloramine   T  -}-  hydrogen   dioxide    396 

Chlorazene  -f-  boric  ac 395 

Chloretone  +  menthol 307 

x 


250  INDEX 

Prescription  No. 

Cocainae  hydrochloridum  -}-  camphor  -}-  chloral  ..............  381 

-(-  collodion    .......................................  21 

-f-  liquid  petrolatum  ................................  99 

-}-  morph.  sulph.  -|-  atropine  sulph.  -\-  petrolatum  ......  350 

-j-  picric  acid  ......................................  86 

-(-  quin.  sulph.  -|-  tannic  ac.  -f-  menthol  -j-  rose  water.  .  .  225 

-|-  sodium  borate  ...................................  28 

Codeina  -|-  ammon.  chloride    ...............................  185 

Collodium  -f  alkaloidal   salts    ..............................  21 

-|-  ammonia  water   ..................................  137 

-f-  ammonia  water  -f-  ether  -(-  tr.  iodine   ..............  138 

-(-  creosote    ........................................  74 

-j-  phenol   ..........................................  74 

-j-  tr.  iodine  ........................................  315 

-f-  zinc  chloride  ....................................  140 

Creosoti  carbonas  -}-  quin.  hydrobrom.  -j-  camphor  monobrom. 

-f-  ergotin    .......................................  533 

Creosotum  -)-  balsam  tolu   .................................  540 

-{-  collodion    ........................................  74 

-|-  guaiacol  (in  pills)   ...............................  321 

-j-  guaiacol  -\-  creosotal  -|-  duotal  -(-  thiocol  (in  powders)  322 

-f-  tr.  ferric  chloride  ................................  214 

Cupri  sulphas  -f-  gallic  acid  ...............................  267 

-|-  sodium  bicarbonate   ..............................  170 

p\ERMATOL  -f  nitrohydrochloric  acid   ...................  299 

Diuretinum.  See  Theobrom.  Sodio-Salicylas. 

Diuretinum  -}-  phosphoric  acid  .............................  128 

-}-  sol.  iron  and  ammon.  acet  .........................  367 

-j-  tr.  ferric  chloride  ................................  126 

-j-  water  ..........................................  127 


+  mercuric  chloride    .....................  318 

*-*  Ess.  pepsini  -j-  dil.  hydrochlor.  ac.  -(-  magma  magnesia.  .  .  389 
Europhen  -f  amylum  .....................................  385 

-f-  cold  cream  ......................................  387 

Exalgin  -|-  phenacetin  .....................................  319 

-+-  phenacetin  -f-  sod.  salicyl  ..........................  320 

Ext.  hyoscyamus  -j-  tannic  ac.  -f-  lard  ..........................  .  118 


INDEX  251 

Prescription  No. 

f^  EL  bovis  -j-  oil  turpentine  -f-  glycerin  541 

Ferri  et  ammonii  citras  -|-  potass,  iodide 213 

Ferri  et  quininae  citras  -\-  potassium  iodide «....„..  218 

-j-  sol.  ammonium  acetate < ....  4 . . .  160 

Ferri  phosphas  -(-  ac.  phosphor,  dil Ill 

sol.  -f-  ac.  phosphoric  » . .  112 

Ferri  pyrophosphas  -|-  ac.  phosphor,  dil , 83 

Ferri  sulphas  -f-  gallic  acid 267 

-|-  sod.  carbon 324 

Ferrum  dialysatum  -f-  sol.  potassium  arsenite  79 

Fluidext.  buchu  -f  spir.  nitrous  ether 72 

-f-  water 336 

Fluidext.  cannabis  indicae  -f-  water 4 

Fluidext.  glycyrrhizae  -(-  dil.  sulphur,  ac 58 

Fluidext.  hyoscyami -(- potass,  bicarbon.  -[-  water 336 

Fluidext.  uvae  ursi -(- spir.  nitrous  ether 71 

/^ILYCERINUM  -f  hydrogen  dioxide 162 

^      -j-  liquid   petrolatum  -f-  menthol    347 

-f  olive  oil  -f  menthol  346 

-j-  potass,  permang '. . . .  51 

-{-  resorcin    409 

-j-  sodium   borate    94 

-f-  sod.  bor.  -f-  sod.  bicarb 15 

Glyceritum  ac.  tannici  -|-  lead  acetate  139 

+  sol.  of  lime  10 

Glyceri.  boroglycerini  -f-  water 114 

Guaiacol  -\-  creosote  (in  pills)   321 

crystall.  (in  pills)  326 

II  ALAZONE  tablets   397 

*•*  Helmitol  -|-  potass,  bicarbon.  -|-  sol.  potass,  hydroxide. . .  392 

Heroina  -|-  ammon.  carbon,  -f  syr.  wild  cherry  316 

Heroini  hydrochlor.  -f-  quin.  hydrochlor.  -|-  creosote  carbonate 

(in  capsules)  532 

Hexamethylenamina  -}-  sodium  acid  phosphate  or  sodium  bi- 

phosphate  40° 

Holocainae  hydrochlor.  -j-  borax  539 

Hydrargyri  chloridum  -f-  sugar  milk  377 


252  INDEX 

Prescription  No. 
Hydrargyri  chloridum  corrosivum  -f  argyrol  -f-  zinc  sulphate. .  282 

-|-  chinosol    308 

-f-  epinephrin    318 

-|-  Fowler's    solution    330 

-f-  hydrogen    dioxide    151 

-[-  lime  water  332 

-|-  lime  water  -}-  lead  water  75 

-)-  lime  water  -f-  muc.  of  acacia  76 

-f-  potass,    iodide    328 

-j-  potass,  iodide  -|-  alkaloids  55,    56 

-f-  potass,  iodide  -f-  comp.  syr.  sarsap 329 

-j-  potass,  iodide  -f-  iron  and  amm.  citrate  -f  tr.  nux  vom. 

-(-  comp.  tr.  cinchona   216 

-}-  potass,  iod.  -j-  tr.  cinchona  comp 56 

-|-  potass,  permanganate  -[-  comp.  sol.  cresol 231 

-{-  potass,  sulphurata  201 

-j-  pyrogallol  380 

-j- sod.  borate    164 

-f-  sol.  potass,  arsenite 121 

-f  syr.  hypophosphites 19 

-f-  tr.  iodine  414 

Hydrargyri  chloridum  mite -{- ammonium  carbonate 147,  176 

-|-  ammonium  chloride  175 

-|-  antipyrine    37 

-f-  antipyrine  -|-  sod.   bicarbon 157 

-|-  antipyrine  -f-  sodium  bromide  -f-  sodium  phosphate  -\- 

sod.  bicarb.  -{-  caffeine  citr 219 

-j-  hydrochloric  ac 177 

-|-  hydrogen  dioxide   150 

4-  iodine  ointment    334 

4-  iodof orm    145 

-j-lime   water    333 

-f-  potassium  bromide 62 

-|-  potassium  chlorate 310 

-f-  potassium  chlorate  -|-  bism.  subnitr 311 

4- potassium  iodide   246 

4-  salicylic  ac.  -f  lime  water   188 

4-soap 143 

-{-sodium  bicarbonate   157 


INDEX  253 

Prescription  No. 

-(-  sodium  chloride  215 

-j-  syr.  of  rhubarb  178 

-)-  thymol  iodide  370 

Hydrargyri  iodidum  flavurn  -|-  potassium  iodide  172 

-\-  potassium  iodide  (in  pill  form)  173 

Hydrargyri  oxidum  flavum  -(-  cocain.  hydrochl 27 

Hydrargyri  salicylas  -j-  potassium  iodide  398 

-f  water  335 

Hydrargyrum  ammoniatum  -f-  sulphur  -[-  potass,  carbon,  -f.  lard  327 

Hydrogen  dioxide.     See  Liq.  Hydrogenii  Dioxidi. 

Hydrogen  perovide.    See  Liq.  Hydrogenii  Dioxidi. 

Hypophosphites  -|-  tr.  ferric  chloride    189 

T  CHTHYOL  -f  acidum  hydrochloricum  116 

-f-  alcoholic  tinctures  117 

-J-  cocaine  hydrochlor 120 

-(-  mercuric  chloride  -j-  potass,  iodide  118 

-|-  quin.  sulph 119 

-j-  strychn.  sulph.  -f-  quinin.  sulph 119 

-j-  zinc  sulphate  337 

locamfen  -(-  water  386 

lodoformum  -|-  bals.  of  Peru  -j-  lard  338 

+•  calomel  145 

-j-  ether  -f-  hydrogen  dioxide  153 

-}-  hydrogen  dioxide  152 

-[-  olive  oil  -j-  hydrogen  dioxide  166 

lodum  -|-  alcohol  -f-  oil  turpentine  131 

-f  argyrol  407 

-J-  glycerin 130 

+  woolfat  109 

TT  AOLINUM  +  salicylic  ac.  -f-  tannic  ac.  -f    alum 373 

T    IQUOR  acidi  arsenosi  +  syr.  hypophosphites 285 

•^      -f  tr.  ferric  chloride   124 

Liquor  ammonii  acetatis  -f-  tr.  ferric  chloride  .' 78 

Liq.  arseni  et  hydrarg.  iodidi  -f  strychn.  sulph 283 

-f-  strychn.  sulph.  -|-  quin.  sulph 284 

Liquor  calcis  -f-  glycerite  tannic  acid 1° 


254  INDEX 

Prescription  No. 

-f-  hydrogen  dioxide 5 

-f-  mercuric  chloride  -f-  lead  water 75 

-j-sod.  benz 250 

-}-  tannic  acid   9 

Liquor  creosolis  corap.  -)-  mercuric  chloride  -|-  potass,  perraan- 

gan 231 

Liquor  f  erri  dialysati  -f  muc.  acacia  -f-  syr.  raspberry  -f-  water  134 
-|-  hydrogen    dioxide    341 

Liquor  hydrogenii  dioxidi  -|-  adrenalin    317 

-f  balsam  of  Peru   168 

-f-  bismuth  subnitrate 167 

-j-  calomel   150 

-f-  chromic  acid   163 

-|-  ether  -f-  iodof orm  153 

+  glycerin  162,  238 

-j-  hypochlorites 148 

-j-  iodoform    152 

-|-  iodoform  -j-  olive   oil    166 

-f-  Labarraque's  solution    148 

-|-  lime  water  5 

-|-  mercuric  chloride  151 

-j-  phenol  -|-  tr.  ferric  chloride   182 

-f-  potassa  sulphurata    200 

-j-  potassium  permanganate    222 

-f  sol.   formaldehyde    341 

-j-  sulphurous  acid    412 

-j-  syr.  hydriodic  acid   221 

-}-  tr.  arnica  -j-  fl.  ex.  calendula 169 

-j-tr.  iodine   192 

-f-  zinc  sulphate 167 

Liquor  plumbi  subacetatis  -f-  boric  acid   92 

-|-  muc.  acacia    68,  123 

-f-  tr.  iodine  382 

-j-  tr.  opium  146 

-j-  mercuric  chloride  -\-  lime  water 75 

Liquor  potassii  arsenitis  -f  dialyzed  iron  79 

-}-  gold  and  sodium  chloride 286 

-j-  mercuric  chloride   121,  330 

-f-  morphine  sulphate ..,..,.     22. 


INDEX  255 

Prescription  No. 
-|-  silver   nitrate    77 

-j-  syr.  ferrous  iodide 417 

-J-  syr.  ferrous  iodide  -|-  Fowler's  solution  -|-  elix.  calisaya  115 

-f-  syr.  ferrous  iodide  -j-  tr.  mix  vomica 210 

-{-  tr.  f  erric  chloride    81 

Liq.  sodae  chlorin  -f-  hydrogen  dioxide  148 

Lithii  citras  -f  sodium  phosphate   342 

-j-  strontium   bromide    103 

IV/fAGNESII   oxidum -f- bismuth  subnitrate  -|-  pancreatin 181 

+  water    13 

Magnesii  sulphas  -|-  aqua  crotonis   312 

-j-  sodium  phosphate    343 

-f-  spir.  peppermint  -)-  water   156 

Massa  ferri  carbonatis  -\-  potassium  carbonate   384 

-f-  salicylic  ac 323 

Menthol  -f  alcohol  -f  water    344 

-j-  camphor    35 

-j-  chloretone   307 

-}-  cocaine  hydrochl.  -j-  quin.  sulph.  -f-  tannic  ac 225 

-(-  eucalyptol  -{-  zinc  sulph.  -\-  liq.  albolene 378 

-j-  olive  oil  -|-  glycerin   346 

-j-  thymol  -f-  eucalyptol  -(-  cocaine  hydrochl.  -\-  liquid  pe- 
trolatum      99 

Mercauro  -f-  strychn.   sulph.  -f-  atropine  sulph 159 

Mist,  rhei  et  sodae  -|-  dil.  hydrochloric  acid  289 

+  pepsin    290 

Morphinae  acetas  -f-  oil  °f  turpentine 198 

Morphinae  hydrochlor.  -j-  potassium  cyanide   158 

Morphinae  sulphas  -f-  ammonium  carbonate  2 

-{-  antikamnia  -(-  quin.  sulpht.  arom.  sulph.  ac 149 

-\-  arom.  spir.  ammonia   36 

-j-  Fowler's  solution   22 

-j-  oleic  acid  100 

-J-  potass,  iodide   59 

-|-  sol.  potass,  hydrox 90 

-f-  spir.   nitrous   ether    89 

-|-  strontium  bromide   102 

-f-  syr.  senega 2 


256  INDEX 

Prescription  No. 

-{-  syr.  wild   cherry    ................................  3 

-(-  tannic  acid    .....................................  1 

-f  tr.  capsicum  -f-  ether  .............................  206 

-|-  tr.  ferric  chloride  ................................  171 

Muc.  acaciae  -f-  sol.  lead  subacetate  ............  .........  68,  123 

-f  tr.  iodine  +  alcohol  ..............................  239 

/~\LEUM  olivae  -f  glycerin   ..............................  346 

^•^     Oleum  terebinth.  -|-  morph.  acet  ......................  198 

Oleum  tiglii  -f-  ol.  ricini  -|-  glycerin   ........................  186 

Oleum  ricini  -4-  glycerin  ...................................  186 

Orthoform  -f-  olive  oil   ....................................  527 


pANCREATINUM  +  dil.   hydrochloric  acid  ...............  348 

*         -\-  pepsin  -j-  dil.  hydrochlor.  ac  ......................  348 

Pepsinum  -}-  pancreatin  -f-  lactopeptine  -[-  hydrochlor.  acid  -|~ 

mist,  rhei  et  sodae  ...............................  416 

-|-  ac.  hydrochlor.  -|-  bismuth  and  ammonium  citrate  ....  291 

-j-  alcoholic'  tinctures   ...............................  212 

-f-  betaine  hydrochlor  ...............................  394 

-j-  mixt.  rhubarb  and  soda  ...........................  290 

-j-  pancreatin  -(-  dil.  hydrochlor.  ac  ....................  348 

-j-  resorcin  -\-  salol    .................................  209 

-}-  sodium  bicarbonate   ..............................  208 

Peroxide  of  hydrogen.     See  Liq.  Hydrogenii  Dioxid/i. 

Petrolatum  liquidum  -|-  glycerin  -(-  -menthol    .................  347 

Phenacetin  -(-  exalgin   .....................................  319 

-f-  exalgin  -f  sod.  salicyl  ............................  320 

Phenol  -f  camphor    .......................................  302 

-f-  camphor  -(-  chloral    ...............................  306 

-(-  collodion    ........................................     74 

excessive  quantity  ..................................     53 

-4-  hydrogen  dioxide  -4-  tr.  ferric  chloride  .............  182 

-}-  potassium  permanganate   .........................  183 

-|-  silver  nitrate  ....................................  351 

•4-  thymol  4-  camphor  -4-  boric  ac  .....................  368 

-j-  tr.  iodine  -f-  muc.  acacia  -f  alcohol   ................  239 

Phenylis  salicylas  -f-  camphor  -4-  antipyrin  ................  352 

-f  spir.  nitrous  ether  -j-  tr.  ferric  chloride  ............  135 


INDEX  257 

Prescription  No. 
Piperazina -f- antipynn,  in  powders   274 

(in    powders)     t  349 

Plumbi   acetas  -f-  alum    105,  106 

-f-  alum   (in  powder)    107 

-f-  glycerite  of  tannic  acid  139 

-f-  potassium  iodide    165 

-|-  sodium  borate  93 

-f  sodium  borate  -f-  glycerin  94 

-f-  zinc  sulphate   54 

-(-  zinc  sulphate  (in  powder  form)    38 

Polypharmacy,  example  of  390 

Potassa  sulphurata  -|-  hydrogen  dioxide   200 

-J-  mercuric  chloride  201 

-j-  zinc  sulphate  -|-  lead  water  217 

Potassii  bromidum  -j-  calomel  62 

-\-  camphor  water  17 

-f-  potass,  citrate  -j-  spir.  chloroform  241 

Potassii  chloras  -|-  calomel 310 

(excessive  quantity)  -f  tr.  ferr.  chlor.  -(-  glycerin  -f-  wa- 
ter         61 

-(-  hydrochloric  acid  60 

-|-  mercurous  chloride  -j-  bism.  subnitrate  311 

-f-  sodium  thiosulphate 309 

-|-  tannic  acid  84 

Potassii  cyanidum  -j-  morph.  sulph 158 

Potassii  glycerinophosphas,  in  capsules   264 

Potassii  hypophosphis  -f-  tr.   ferric  chloride    189 

Potassii  iodidum  -|-  argyrol 407 

-|-  bismuth  subnitrate 292 

-j-  dil.  sulphuric  acid  40 

-flard  110 

-f-  lead  acetate  165 

-|-  nitro  hydrochloric  ac 195 

-f-  quin.  sulph.  -|-  dil.  sulphur,  acid  40 

-f-  sodium  iodide  -(-  spir.  nitrous  ether  360 

-j-  sod.  thiosulph 359 

-|-  spir.  nitrous  ether   26,  523 

-f-  syr.  ferr.  iodide 73 


258  INDEX 

Prescription  No. 

-f-  tartaric  acid  144 

4-  tine,  of  ferric  chloride  16 

Potassii  permanganos  -(-  ferrous  sulphate  -{-  dil.  sulphuric  acid .  193 

4~  glycerin  51 

-|-  hydrogen  dioxide  222 

4.  morph.  sulph.  4-  ext.  glycyrr 88 

4-  organic  substances  (in  pill  form) 52 

-f  phenol  183 

-j-  pyrogallol  355 

4-  salicylic  acid 184 

-j-  silver  nitrate 154 

4-  tannic  acid  85 

-j- thymol  -f  alcohol  372 

Potassii  et  sodii  tartras  -f  acid  -}-  alcohol 161 

-j-  arom.  sulphur,  ac 252 

-|-  tr.  ferric  chloride  161 

Protargol  -f-  cocaine  hydrochlor 411 

4-  lead  acetate  4-  silver  nitrate 353 

-}-  water  ' 235 

4-  zinc  sulphate 6 

Pulvis  cretae  comp.  -}-  elixir  of  vitriol 260 

Pulv.  rhei  comp.  4- dil.  hydrochlor.  ac 261 

Pyramidon  4-  brometone  530 

4-  spir.  nitrous  ether 354 

Pyrogallol  -f-  mercuric  chloride 380 

4-  potassium  permanganate  355 

QUININAE  bisulphas.  4-  ammonium  carbonate 18 
4-  resorcin    356 

4-  sodium  benzoate  248 

Quininae  hydrochloridum  4-  ammonium  carbonate 205 

Quinin.  sulphas  4-  a°id  sulph.  dil.  4-  fluid  ext.  glycyrrhiza ....     58 

4-  aspirin    413 

-|-  arom.  spir.  ammonia  4-  tr.  ferric  chloride  82 

-j-  potassium  iodide  4-  dil.  sulphur,  acid 40 

-j-  potass,  iodide  -j-  tartaric  acid    144 

4  sod.  acetate  4.  dil.  sulph.  ac 30 

-j-  sodium  benzoate  249 


INDEX 

sulphur,  i 
-f  tr.  ferric  chloride -j- dil.  sulph.  acid 34 


Prescription  No 
-f  sod.  salicyl.  -f  dil.  sulphur,  dil 29 


r>  ESORCINOL  4- acetanilid    257 

**      +  acetanilid  -f-  thymol  258 

-j-  antipyrine  -f-  phenacetin    196 

-f-  benzoinol    542 

-j-  glycerin    409 

-f-  quin.  bisulph 356 

-|-  petrolatum  liquidum   408 

-|-  tr.  ferric  chloride   197 

O  ALICINUM  -|-  quin.  sulph.  -f  dil.  sulphuric  ac 224 

Saliformin  -\-  water   393 

Salol.    See  Phenyl  Salicylas. 

Salophen  -j-  sodium   bicarbonate    399 

Santoninum  -|-  calomel 391 

Sapo  -f-  calomel   143 

Shotgun  prescription,  example  of 390 

Sodii  acetas  -|-  quin.  sulph.  -[-  dil.  sulphuric  acid 30 

Sodii  benzoas  -f-  quin.  bisulph 248 

-f  citric  acid    288 

-|-  dil.  phosph.  ac.  -f-  syr-  of  lemon 287 

-j-  lime  water 250 

-{-  quinine  sulph 249 

-|-  syrup  of  lemon  -(-  syr.  of  citric  acid 254 

-f-  tr.  ferric  chloride 194 

Sodii  bicarbonas,  25  per  cent,  solution 63 

-f  ac.  salicyl 69,    70 

-j-  bismuth  subnitrate    41 

-f-  strontium  bromide  410 

-j-  sod.   bor.  -f-  glycerin 15 

Sodii  boras  -)-  acacia  -f-  syrup  -j-  water  227 

-f-  acacia  -f-  water   226 

-f-  ac.  salicyl.  -|-  glycerin  -{-  water 230 

-f-  alum  -\-  glycerin  -|-  water     244 

-\-  alum   (in  powder) 357 

-j-  cocaine  hydrochlor 28 

^j- mercuric   chloride    164 


260  INDEX 

Prescription  No. 

+  lead  acetate 93 

-j-  lead  acetate  -f-  glycerin 94 

-|-  sod.  bicarb.  -|-  glycerin 15 

-f-  zinc  sulphate  -f-  glycerin    95 

Sodii  bromidum  -f-  camphor  water 17 

Sodii   glycerinophosphas — in   powders 263 

-f-  quin.  sulph.  -j-  strychn.  sulph.    (in  pills) 325 

Sodii  hyposulphis.    See  Sodii  Thiosulphas. 

Sodii  iodidum -f- elix.  iron,  quinine  and  strychnine  phosph....  528 

Sodii   perboras  -(-  water    358 

Sodii  phosphas  -f-  lithium  citrate   342 

-|-  magn.  sulph 343 

Sodii  salicylas  -(-  antipyrin  25 

-}-  citrated  caffeine  406 

-\-  citric  acid  -j-  syr.   of  raspberry 87 

-j-  dil.  sulph.  ac 29 

-j-  dil.  sulph.  ac.  -|-  quin.  sulph 29 

-j-  hexa  -}-  spir.  nitrous  ether  -f-  water 232 

-f-  sodium  bicarbonate   155 

-j-  spir.  nitrous  ether 66 

-j-  syrup  of  lemon 253 

-j-  syr.  of  raspberry 39 

-j-  tr.  ferric  chloride 33 

Sodii  sulphis  -)-  hydrochloric  ac 132 

Sodii  thiosulphas  -|-  potass,   chlorate 309 

-}-  sulphuric  acid  207 

Sol.  Magendie  -f  Fowler's  solution 22 

-j-  potass,  iodide   59 

Sol.  morphinae  sulph 376 

Sparteinae  sulphas  (in  tablets) 531 

Spir.  aetheris  nitrosi  -|-  acetanilid    256 

4-  antipyrin   24 

-f  fl.  ext.  buchu 72 

-f-  fl-  ext.  uva  ursi 71 

-f  iodides    360 

-j-  morph.  sulph 89 

-J-  potassium  iodide   26 

-j-  pyramidan   354 

-j-  sod.  salicyl 66 


INDEX  261 

Prescription  No. 

Spir.  ammoniac  aromaticus  -4-  morph.  sulph 36 

-f-  sod.  brom.  -j-  water  361 

-j-  sol.  of  lime 14 

-j-  syr.  of  nutgalls 174 

-j-  tr.    ferric   chlor.  -{-  quin.    sulph 82 

-|-tr.  ferric  chloride -f- sod.  salicyl.  -4-  quin.  sulph 125 

-j-  water    14 

Spir.  menthae  piper,  -f-  water 14 

Spir.  camphorae  -4-  peppermint  water 243 

+  water    301 

Spir.  chloroformi  -|-  potass,  brom.  -4-  potass,  citr.  -4-  water 241 

Spir.  pimentae  -4-  tine,  of  ferric  chloride 8 

Strontii  bromidum   (in  powders) 101 

-(-  lithium  citrate 103 

-j-  mixt.  rhubarb  and  soda 410 

-|-  morph.  sulph.  . .' 102 

-f-  sod.  bicarb 104,  410 

Strontii  iodidum  -4-  morph.  sulph 102 

Strychninae   hydrochlor. -}-dil.   hydrochlor.   ac 362 

Strychninae  sulphas  -f-  Donovan's  solution 283 

-j-  Fowler's  sol.  -(-  syr.  ferrous  iodide  -f-  elixir  calisaya . .  115 

-f-  potassium   bromide    42 

-f- potassium   bromide  -f-  spir.   frumenti 43 

quantity  for  20  pills  made  into  one 262 

-f-  quin.  sulph.  -j-  sod.  glycerophosph 325 

-|-  sodium  phosphate   44 

-j- sol.  potass,  hydrox 91 

Sulphonal  -4-  chloral   365 

-4-  trional  -4-  urethane    364 

Syr.   acidi   hydriodici  -f-  hydrogen   dioxide 221 

Syr.  ferri  iodidi  -4-  Fowler's  solution 210,  417 

-\-  potass,  iodide   73 

Syr.  gallae  -4-  arom.  spir.  ammonia 174 

Syr.  hypophosphitum  compos.  -4-  sol.  arsenous  acid 285 

Syr.  hypophosphitum  -4-  mercuric  chloride 19 

-4-  silver  nitrate  20 

-|-  tr.  ferric  chloride    190 

-j-  tr.  ferric  chloride  -4-  water 191 

Syr.  rhei -f  calomel   178 


262  INDEX 

Prescription  No. 

rp  HEOBROMINAE-SODII  salicylas  -f-  acids 128 

*        -j-  mercuric   chloride  -(-  potassium   iodide. . .  •. 233 

-\-  tr.  of  iron 126 

Theobromine-sodium      acetate  -f-  sparteine      sulph.  -j-  syrup  -J- 

strychn.  sulph 366 

Thymol  -f  acetanilid  -f-  resorcin     258 

-[-  camphor  -j-  phenol  -f-  boric  ac 368 

Thymolis  iodidum  -f-  calomel  370 

-j-  starch   369 

Tinctura  digitalis  -f  tr.  ferric  chloride 202 

-f-  tr.  strophanthus  -j-  sparteine  sulph.  -f-  strychn.  sulph.  374 

Tinctura  ferri  chloridi  -\-  ammon.  benzoate  -f-  sod.  benzoate. . . .  194 

-J-  ammon.   tr.  valerian 199 

-(-  antipyrin   65 

-j-  cinnamon  water   7 

-}-  creosote  water 214 

-f-  hypophosphites  189 

-f  methyl  salicyl 345 

-f-  morph.    sulph 171 

-j-  muc.  acacia  -f-  syrup  -{-  water 133 

-(-  oil  of  wintergreen 64 

-|-  phenacetin   234 

-f-  phenol  -f-  hydrogen  dioxide  182 

-j-  potassium  bromide 179 

-f-  potassium  iodide    16 

-j-  quin.  sulph.  -f-  arom.  spir.  ammonia 82 

-}-  resorcin    197 

-|-  salol  -(-  spir.  nitrous  ether 135 

-|-  sodium  bromide   179 

-|-  sod.  salicylate  33 

-}-  sol.  ammon.  acetate  78 

-f-  sol.  arsenic  trioxide  -)-  quin.  sulph.  -f-  inf.  cinchona . . .  124 

-j-  sol.  potass,  arsenite 81 

-j-  spir.  pimenta   8 

-j-  syr.  hypophosphites  -(-  water    191 

-f-  tr.  cinchona 57 

-f  tr.  digitalis  202 

-j-  tr.  gentian  194 

-f-  tr.    nux.    vom.  -f  tr.    digitalis  -f  quin.    sulph.  -j-  sod. 

salicyl.  -f-  arom.  spir.  ammonia 125 


263 

Prescription  No. 
Tmetura  guaiaci  -(-  water   .................................     11 

Tinctura  iodi  -|-  albolene   ..................................  525 

-f-  ammonia  water  ..................................  526 

-f-  ammonia  water  -j-  soap  liniment  ...................  339 

-|-  collodion    .......................................  315 

-f  glycerin  -|-  water    ................................  129 

4-  hydrogen  dioxide  ................................  192 

-}-  mercuric  chloride  ................................  414 

-j-  sol.  lead  subacetate   ..............................  382 

Tinctura   nucis   vom.  -)-  charcoal  ............................  304 

-j-  comp.  tr.   of  gentian  ........  '.  ....................  418 

-|-  Fowler's  solution  -(-  syr.  ferrous  iodide  -(-  elix.  calisaya  115 
-f-  tr.  digitalis  -(-  tr.  ferric  chloride  -j-  phosphoric  ac.  -{- 

water    .......................................  141 

-f-  water  ...........................................  418 

Tinctura  opii  -j-  sol.  lead  subacetate  .........................  146 

Tinctura  valerianae  ammoniata  -j-  tr.  ferric  chloride  .........  199 

Trinitrophenol.     See  Acidum  Picricum. 

Trional  -(-  chloral    ........................................  363 

-(-  sulphonal  -f-  urethane    ............................  364 

T  T  NG.  hydrargyri  -f-  iodine  oint  ...........................  340 

^      Ung.  iodi  +  calomel    ................................  334 

-j-  ung.  hydrargyri   .................................  340 

Ung.  zinci  ox.  -f-  lime  water  ................................  242 

Urethan  -f  trional  -f-  sulphonal  ...........................  364 

Urotropin  -f-  atophan    .....................................  229 


chloridum  +  collodion  ...........................  140 

Zinci  iodidum  -|-  water   ..............................  136 

Zinci   phosphidum  -}-  phosphoric    acid  .......................  142 

Zinci  sulphas  -f  argyrol  ...................................  28° 

-f  bism.  subnitr.  -f  lead  water  -f  liver  of  sulphur  .....  217 

-|-  lead  acetate  .....................................  ^4 

4-  lead  acetate  (in  powder  form)  ....................  38 

4-liq.   albolene    ....................................  378 

-f  protargol    ....................................... 

+  sod.borate  108 


-  sodium  borate  -j-  glycerin    ........................ 

4-  tannic  ac.  -j-  water   ..............................  371 


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other  disorders  in  their  patients  or  in  themselves,  but 
that  it  opened  their  eyes  to  the  significance  of  many 
things  which  they  did  not  understand  before. 

Those  who  have  read  the  book  know  its  value  and 
importance;  those  who  have  not  may  be  interested  to 
read  what  the  medical  journals  have  to  say  about  it, 
Here  are  a  few  extracts: 

No  American  authority  has  given  more  serious  thought 
to  the  subject  of  sexual  diseases  than  the  author  of  this 
volume;  he  has  given  to  us  in  it  the  best  that  in  him  lies. 
No  physician  who  has  had  to  combat  this  distressing  condi- 
tion, and  those  conditions  dependent  upon  it,  has  any  doubt 
of  its  serious  importance.  And  we  all  recognize  the  weak- 
ness af  the  literature  on  the  subject.  Dr.  Robinson  takes. 


SEXUAL   IMPOTENCE 

a  sensible  view  of  things  which  have  not  been  sensibly  con- 
sidered; nowhere  has  he  shown  this  to  better  advantage 
than  in  this  volume  on  a  difficult  subject. 

—Medical   Fortnightly. 

Dr.  Robinson  discusses  the  numerous  phases  of  this  sub- 
ject, in  both  sexes,  clearly  and  in  detail.  He  tells  no  lies 
to  conform  to  moral,  social  and  religious  ideals,  and  con- 
sequently those  who  differ  with  him  in  beliefs  or  in  pre- 
tensions may  censure  him  as  immoral.  In  some  of  these 
points  there  is  opportunity  for  difference  of  opinion,  but 
on  the  whole  we  think  that  Dr.  Robinson  has  expressed 
what  the  majority  of  physicians  believe,  tho  not  necessarily 
the  opinion  most  frequently  published.  Pretty  nearly 
every  conceivable  sexual  abnormality,  physical  or  psychic 
is  at  least  alluded  to.  If  we  were  to  select  any  one  feature 
of  this  work  for  special  mention,  it  would  be  the  uniform 
common  sense  of  the  author. — Buffalo  Medical  Journal. 

This  book  is  not  by  any  means  a  rehash  of  some  other 
book  or  a  resume  of  several.  This  treatise  is  interesting 
and  valuable,  and  the  author  is  absolutely  honest  and  fear- 
less in  his  opinions.  A  unique  and  helpful  feature  is  the 
case  reports  which  illustrate  every  phase  of  sexual  dis- 
order.— Indianapolis  Medical  Journal. 

Dr.  Robinson  deals  with  the  subject  in  a  dignified,  scien- 
tific way,  that  will  be  helpful  to  the  physician  who  has» 
judgment  enough  to  realize  that  he  is  as  responsible  for 
functions  around  which  a  modern,  sham,  conventional 
modesty  has  thrown  a  hiatus  of  folly  as  he  is  for  the  ap- 
petite, eliminative  powers  or  nutritive  functions  of  the  same 
persons.  And  the  science  of  eugenics  can  never  be  worthy 
of  medical  consideration  until  the  people  are  taught  that 
it  is  as  much  the  duty  and  ousiness  of  physicians  to  in- 
quire about  the  sexual  habits  of  patients  as  of  their  habits 
of  eating  and  drinking.  This  book  will  do  much  good,  and 
that  good  will  be  as  extensive  as  its  reading. 

— Texas  State  Journal  of  Medicine. 


SEXUAL  IMPOTENCE 

In  this  book  we  have  a  complete  treatise  on  sexual  dis- 
orders and  their  treatment,  with  descriptions  of  actual 
individual  ca°es,  giving  the  individual  symptomatology  and 
individual  treatment.  When  given  in  this  manner  the  de- 
scription becomes  indelibly  impressed  on  the  memory  and 
enables  a  physician  when  he  gets  a  case  to  understand  and 
classify  it  without  a  great  amount  of  difficulty. 

— Charlotte   Medical   Journal. 

The  name  of  the  author  is  ample  assurance  that  this 
treatise  is  not  a  rehash  nor  lacking  in  honest  opinions  fear- 
lessly expressed.  The  style  of  the  writer  is  notably  per- 
sonal, clear,  straightforward  and  conversational.  The  ex- 
haustion of  the  first  edition  in  less  than  two  months  from 
the  day  of  publication  shows  unmistakably  the  need  of 
a  book  of  this  character.  It  also  shows  that  the  profession 
is  at  last  becoming  alive  to  its  shortcomings  in  the  matter 
of  sexual  disorders  and  is  beginning  to  be  willing  to  learn. 
— Southern  California  Practitioner. 

Perhaps  no  subject  pertaining  to  human  ills  has  been  so 
neglected  by  medical  teachers  or  medical  text-books  as 
the  subject  discussed  in  this  volume.  While  legitimate 
medical  literature  was  indiscreetly  silent  on  sex  teachings, 
the  quack  literature  was  teeming  with  misinformation, 
which,  as  the  author  intimates,  did  more  real  harm  than 
did  sexual  ignorance  or  sex  abuse.  The  doctor  will  find 
this  work  instructive.— Illinois  Medical  Journal. 

As  is  to  be  expected  Robinson  goes  into  the  subject 
thoroly,  and  calls  a  spade  a  spade,  with  the  result  that  he 
has  evolved  a  volume  full  of  meat  and  of  great  value  to 
the  physician,  whose  ingenuity  is  often  taxed  to  the  ut- 
most to  discover  the  whys  and  wherefores  at  the  bottom  of 
impotence.  The  racy  Robinsonesque  style  adds  interest  to 
ihe  text  matter  of  .the  volume.— Medical 


At  last  we  have  a  clear,  plain,  concise  book  on  the  treat- 
ment of  Gonorrhea  and  its  various  complications,  written 
expressly  for  the  general  practitioner. 

No  Physician  who  has  occasion  to  treat  Gonorrhea  can  do  justice  to  his 
Patient  without  a  study  of  this  latest  and  clearest  volume  on  the  subject. 

THE  TREATMENT  OF 

GONORRHEA 

And  Its  Complications  in  Men  and  Women. 

For  the  General  Practitioner. 

By 

WILLIAM  J.  ROBINSON, 
M.D. 

An  idea  of  the  scope  of  this  work  may  be  gained  from  the  Chapter  Headings; 
I.  Extent  and  Seriousness  of  Gonorrhea.  2.  Classification  of  Urethra* 
Inflammations.  3.  Gonorrhea!  Urethritis  in  the  Male.  4.  The  Germ  and  the 
Diagnosis  of  Gonorrhea.  5.  Course  and  Symptomatology  of  Acute  Gonorrhea. 
6.  Treatment  of  Acute  Gonorrhea.  7.  Case  Reports.  8.  Common  Bacterial  Ure- 
thritis. 9.  Chancroidal  Urethritis.  10.  Syphilitic  Urethritis.  n.  Chemic&l 
Urethritis.  12.  Prophylactic  Urethritis.  13.  Traumatic  Urethritis.  14.  Toxic 
Urethritis.  15.  Urethritis  from  Excess  and  Masturbation.  16.  The  Widely  Vary- 
ing Conditions  Known  as  Chronic  Gonorrhea.  17.  Treatment  of  Chronic  Gonor- 
rhea. 18.  Length  of  Time  Required  to  Cure  Chronic  Gonorrheal  Conditions.  19. 
Instruments  Used  in  Treatment.  20.  Abortive  Treatment.  21.  Prevention  of 
Gonorrhea.  22.  Minor  Complications  of  Gonorrhea  (Phimosis,  Paraphimosis, 
Balanitis,  Adenitis,  Painful  Erections  and  Chordee,  Retention  of  Urine).  23.  Acute 
Prostatitis.  24.  Chronic  Prostatitis.  25.  Epididymitis.  26.  Seminal  Vesiculitis. 
27.  Gonorrhea  of  the  Rectum.  28.  Gonorrhea  of  the  Mouth.  29.  Stricture. 
30.  Gonorrheal  Rheumatism.  31.  Gonorrhea  vs.  Tobacco,  Alcohol  and  Sexual 
Intercourse.  32.  Gonorrhea  in  Women.  33.  Vulvovaginitis  in  Little  Girls.  34. 
Gonorrheal  Ophthalmia.  35.  Minor  Points.  Part  II. — Materia  Medica  of  Gonor- 
rheal and  Non-Gonorrheal  Urethritis  and  Their  Complications.  36.  Silver  Salts 
— Inorranic  and  Organic.  37.  Miscellaneous  Antiseptics  and  Astringents.  38. 
Vegetable  Astringents.  39.  Local  Anesthetics.  40.  Anti-Gonorrheal  Remediei 
for  Internal  Use.  41.  Urinary  Antiseptics.  42.  Lubricants.  43.  Formulary. 

315  pages,  cloth,  $3.00  postpaid 

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Population  and  Birth  Control 

A    SYMPOSIUM 

EDITED  BY 

EDEN  and  CEDAR  PAUL 

One  of  the  greatest  books  on  Birth-Control  in 
the  English  or  any  other  language.   By  writers 
of  international  reputation. 
CONTENTS 

Introduction,  by  William  J.  Robinson;  Mai  thus,  a  Biographical 
and  Critical  Study,  by  Achille  Loria;  Birth-Control  and  the  Wage 
Earners,  by  Charles  V.  Drysdale;  Race  Suicide  in  the  United 
States,  by  Ludwig  Quessel;  Eugenics,  Birth-Control,  and  Social- 
ism, by  Eden  Paul;  Economics  of  the  Birth  Strike,  by  Ludwig 
Quessel;  Decline  in  the  Birth-Rate,  Nationality,  and  Civilisation, 
by  Edward  Bernstein;  Philosophy  of  the  Birth  Strike,  by  Ludwig 
Quessel;  Over-Population  as  a  Cause  of  War,  by  B.  Dunlop;  The 
Decline  in  the  Birth-Rate,  by  R.  Manschke;  Dysgenic  Tendencies 
of  Birth-Control  and  of  the  Feminist  Movement,  by  S.  H.  Half  or  d ; 
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mary and  Conclusion. 

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DR.  WILLIAM  J.  ROBINSON 

PROFESSOR  A.  GROTJAHN 

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IN  PRESS 

SEXUAL  TRUTHS 

VERSUS 

SEXUAL  LIES,  MISCONCEPTIONS 
AND    EXAGGERATIONS, 


Edited  By 
WILLIAM  J.  ROBINSON,  M.D. 


This  book  effectually  demolishes  the 
numerous  lies  and  senseless  exaggera- 
tions which  dabblers  in  sexology,  either 
through  ignorance  or  design,  are  offering 
to  the  public,  and  which  are  responsible 
for  so  much  physical  misery  and  mental 
agony.  Clear,  concise  and  incisive. 

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THE  AMERICAN  JOURNAL 

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UROLOGY  AND  SEXOLOGY 


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The  only  journal  in  the  English  lan- 
guage devoted  to  Sexology.  Discusses 
Human  Sexuality  in  all  its  phases: 
sexual  ethics,  sexual  psychology,  the 
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the  sex  organs,  venereal  prophylaxis, 
limitation  of  offspring,  positive  and 
negative  eugenics,  etc.  Publishes  the 
best  work  from  the  pens  of  the  foremost 
American  and  European  sexologists. 

Nobody  earnestly  interested  in  the  new 
Science  of  Sex  can  afford  to  be  without 
this  journal. 

Published  Monthly 


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SEX  MORALITY 

PAST,  PRESENT  AND  FUTURE 

Will  monogamy  or  variety  prevail 
in  the  future  ? 

Is  continence  injurious  ? 

Are  extra  -  marital  relations  ever 
justifiable  ? 

Should  there  be  one  moral  stand- 
ard for  men  and  women  ? 

Will  our  present  moral  code  persist? 

These  and  similar  questions  are  here  discussed 
by  original  and  unbiased  thinkers  as  well  as  by 
orthodox  conservatives.  No  matter  what  your 
opinion  on  the  subject  may  be,  no  matter  whether 
your  ideas  on  the  relations  of  the  sexes  are  those 
of  the  1  5th,  20th  or  25th  century,  you  should 
read  this  book.  Nobody  who  is  earnestly  inter- 
ested in  the  sex  question  has  a  right  to  have  any 
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It  is  the  most  original  journal  in  the  country.  It  is  the  only 
one  of  its  kind,  and  is  interesting  from  cover  to  cover.  There  is  no 
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that  is  opened  with  anticipation  just  as  soon  as  it  is  received  and 
of  which  every  line  is  read  with  real  interest. 

Not  only  are  the  special  problems  of  the  medical  profession  itself 
dealt  with  in  a  vigorous  and  progressive  spirit,  but  the  larger,  social 
aspects  of  medicine  and  physiology  are  discussed  in  a  fearless  and 
radical  manner. 

Many  problems  untouched  by  other  publications,  such  as  the  sex 
question  in  all  its  varied  phases,  the  economic  causes  of  disease  and 
other  problems  in  medical  sociology,  are  treated  boldly  and  freely 
from  the  standpoint  of  modern  science.  In  discussing  questions 
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THE  CRITIC  AND  GUIDE  was  a  pioneer  in  the  propaganda  for 
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interesting  and  outspoken  matter  on  these  subjects  than  any  other 
journal. 

While  of  great  value  to  the  practitioner  for  therapeutic  sugges- 
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UNIVERSITY  OF  CALIFORNIA  LIBRARY 

Los  Angeles 
This  book  is  DUE  on  the  last  date  stamped  below. 


N  4      1982 
MAY20RECD 

—•MAR   3134 
i»» 


Form  L9-30m-7,'56(C824s4)444 


146 


